Chapter 21

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Communication and Therapeutic Relationships
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1

Communication:

a dynamic, two-way process of sending and receving messages

2

Messages may be:

verbal, nonverbal, or both; may involve 2 or more people.

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Intrapersonal communication:

Conscious internal dialogue; known as self-talk

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Interpersonal communication:

occurs between 2 or more people; face to face conversation between 2 people is the most frequent form

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Group communication:

interaction that occurs among several people

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Small-group communication:

occurs when you engage in an exchange of ideas with 2 or more individuals at the same time

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Public speaking:

a unique form of group communication; speaker addresses a doze to hundreds of people, with varying degrees of interaction

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Communication has 2 major components:

content and process

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Content of communication describes:

the actual subject matter, words, gestures and substance of the message

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Process refers to:

the act of sending, receiving, interpreting and reacting to the message

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The communication process has 5 elements:

sender, message, receiver, feedback and channel

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Sender:

begins the conversation to deliver a message to another person

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Encoding:

refers to the process of selecting the words, gestures, tone of voice, signs and symbols used to transmit the message

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Message:

the verbal and/or nonverbal information the sender communicates

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Channel:

the medium used to send the message

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Receiver:

the observer, listener, and interpreter of the message

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Feedback:

may be verbal, nonverbal or both; once the receiver has received and interpreted the message, he may be stimulated to respond by providing feedback to the sender.

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Verbal communication:

the use of spoken and written words to send a message

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It is your responsibility to deliver messages that the client can understand, therefore:

use medical terms only when you are certain the listener understands them

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Denotation:

the literal meaning of the word

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Connotation:

the implied or emotional meaning of the word

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intonation:

reflects the feeling behind the words

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Clarity in communications requires:

that you select words that convey the intended meaning and that you make sure your spoken words and the nonverbal language send the same message.

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Timing and relevance:

consider the presence of others, communication is effective when both parties value the interaction and find the discussion relevant, the interaction must allow time for response

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Credibility:

believability

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Give information only if:

you are certain of the facts

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If a situation makes you uncomfortable:

it is better to acknowledge your discomfort than to risk loss of credibility

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Always be:

open and honest with patients

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To be credible:

your nonverbal communication must match your spoken words

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Laughter can create physiological changes that contribute to:

well-being and provide an emotional release in a tense situation, thus positively influencing the patient's attitude and healing

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Nonverbal communication is the:

exchange of messages without the use of words

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What factors affect communication?

environment, developmental variations, gender, personal space, territoriality, sociocultural factors, roles & relationships

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Communication is most successful in an environment that is:

quiet, private, free of unpleasant smells and at a comfortable temperature

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You will need to modify your communication strategies to:

fit your client's developmental level

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Women tend to communication to form:

connections and establish relationships

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Male communication styles typically focus on:

goals, tasks, and maintaining independence and favorable positions in hierarchy.

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People vary in the amount of:

physical space they are comfortable with when communicating

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What are the 4 distinct distances influencing communication?

Intimate distance, personal distance, social distance, and public distance

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Intimate distance is:

the area immediately surrounding people that they define as their private space.

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Personal distance is:

a distance of 18 inches to 4 feet.

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Social distance is:

a distance of 4 to 12 feet.

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Public distance is:

considered to be beyond 12 feet.

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Territoriality refers to:

the space and things that an individual identifies as belonging to him.

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Sociocultural factors:

facial expressions, nonverbal communication and even the selection of whom to interact with are affected.

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A passive approach:

avoids conflict and allows others to take the lead

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Aggressive approach:

forces others to lose

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A nonassertive style:

communicating their needs in a style that assures them that they are not telling them what to do.

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Assertive communication is:

the expression of a wide range of positive and negative thoughts and feelings in a style that is direct, open, honest, spontaneous, responsible and nonjudgmental.

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How do you communicate assertively?

question care decisions openly and honestly, use "I statements", focus on the issue, not the participants, use effective nonverbal language, don't invite negative responses, use fogging to help you accept criticism without becoming anxious or defensive, use negative inquiry, strive for a workable compromise.

50

Use critical (CUS) language:

Concerned, uncomfortable, safety - "i'm concerned, I'm uncomfortable, this is unsafe or I'm scared"

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SBAR Model:

Situation, Background, Assessment, Recommendation.

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Patient rounding:

collaborative approach in which physicians and nurses gather at the patient's bedside to discuss goals for care and/or changes in the plan of care and to answer the questions of the patient, family and healthcare staff.

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Therapeutic relationships:

focuses on improving the health of the client, whether an individual or community.

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Therapeutic communication:

A client-centered communication directed at achieving client goals

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Therapeutic relationship consists of 4 phases:

Pre-interaction phase, orientation phase, working phase, and termination phase.

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Pre-interaction phase:

you begin establishing communication by gathering information about the client, but the nurse and client do not have direct communication

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Orientation phase:

Goal is to establish rapport and trust through the use of verbal and nonverbal communication.

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Working phase:

The nurse communicates caring, the patient expresses thoughts and feelings, mutual respect is maintained, and honest verbal and nonverbal expression occurs

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Termination phase:

reviewing and summarizing help to bring the relationship to a comfortable conclusion

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5 key characteristics of therapeutic communication:

Empathy, respect, genuineness, concreteness and confrontation

61

Empathy is:

the desire to understand and be sensitive to the feelings, beliefs, and situation of another person

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Respect is:

valuing the client and being flexible to meet the client's needs

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Genuineness:

the ability to respond honestly

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Concreteness and confrontation:

You must offer understandable responses to a client's questions and concerns; to do so requires you to express in concrete, specific terms that you mean

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Group communication occurs when:

you interact with a family, a community or a committee.

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Groups can enhance:

problem-solving, creativity, generate understanding and support, enhance morale, and provide affiliation

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Task groups are formed to:

address a task or fulfill a need

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Ongoing groups:

address issues that are recurrent

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Self-help groups:

are voluntary organizations composed of individuals with a common need

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Therapy groups are:

organized to help individual members cope with challenging personal issues or stressful life events, such as divorce, death of a suppose or new motherhood

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Work-related social support groups help:

members of a profession cope with the stress associated with their work

72

Active listening is:

when you're giving full attention and allows the sender the opportunity to complete comments without interruption

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clarifying messages helps ensure that:

you have accurately interpreted the information

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Restating means:

using your own words to summarize the message you received from the client.

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To validate the message:

ask the client whether you are making a correct interpretation

76

Process recording:

two people converse while a third records the conversation