Professional Documents
Culture Documents
Therapeutic Com. Module Students
Therapeutic Com. Module Students
Therapeutic Com. Module Students
Module 8
THERAPEUTIC COMMUNICATION
This learning guide is designed to provide an overview and discussion related to the concept
of Therapeutic Communication. It aims to increase a student’s theoretical knowledge of the
elements, characteristics, goals, phases and techniques to be an effective communicator
and apply the skills and knowledge in each phase of the nursing process. It gives emphasis
on the significance of developing critical thinking abilities in order to practice safe,
appropriate nurse patient interaction.
Learning Outcomes: On successful completion of this module, students will be able to:
1. Apply knowledge of physical, social, natural, health sciences and humanities in the
practice of nursing.
2. Provide safe, appropriate, and holistic care to individuals, families, population groups,
and community utilizing nursing process
3. Apply guidelines and principles of evidence-based practice in the delivery of care
4. Document properly to include reporting an up-to-date client care accurately and
comprehensively
5. Communicate effectively using therapeutic and culturally sensitive language in the
nurse/ patient/family interactions
Objectives: This learning module addresses and provide an overview, description, and
fundamental concepts related to the Communication process. Upon completion of this module,
the student will:
Methods/Instructional Technique
Synchronous and Asynchronous Session
Questioning
Video recording and simulation
Research work and analysis
Self-Evaluation/Supply Type of Test
Materials
Electronic gadgets, Paper and Pen, Power point Presentation, learning and teaching guide
Reference books/journals/articles/websites
Duration: 3 hours
Lessons
Topic 1: Communication
Topic 2: Therapeutic Communication
Topic 3: Communication and the Nursing Process
PRE TEST
Instructions: Read the following statements carefully. Write COMMUNICATION if the
statement is TRUE/CORRECT and PROCESS if the statement is FALSE/INCORRECT on
the space provided before each number.
________1. Communication is a two-way process involving the sending and the receiving of a
message.
________2. Decoding involves the selection of specific signs or symbols (codes) to transmit the
message, such as which language and words to use, how to arrange the words, and what tone
of voice and gestures to use
________3. Ineffective communication occurs when the receiver misinterprets the sent
message.
________4. Communication is generally carried out in two different modes: verbal and
nonverbal.
________5. The nurse needs to alter spoken messages in accordance with behavioral cues
from the client.
________6. Verbal communication often tells others more about what a person is feeling than
what is actually being stated
________7. Proxemics is the study of distance between people in their interactions.
________8. What the nurse says and how it is said must be patterned, carefully considered and
the same for every patient.
________9. The use of humor can be a positive and powerful tool in the nurse–client
relationship, but it must be used with care
_______10. Values are the standards that influence behavior, and perceptions are the personal
view of an event.
LECTURE GUIDE/ DISCUSSION
Topic 1: COMMUNICATION
Effective communication between the nurse and the patient is important for the successful
outcome of any care to each patient. It requires an understanding of the patient and the
experiences they express. It requires skills and simultaneously the sincere intention of the nurse
to understand what concerns the patient.
Communication is a critical skill for nursing. It is the process by which humans meet their
survival needs, build relationships, and experience emotions. In nursing, communication is a
dynamic process used to gather assessment data, to teach and persuade, and to express
caring and comfort.
The term communication has various meanings, depending on the context in which it is used.
To some, communication is the interchange of information between two or more people; in other
words, the exchange of ideas or thoughts. This kind of communication uses methods such as
talking and listening or writing and reading.
Nursing as a health care science, focuses on serving the needs of human as a biopsychosocial
and spiritual being. Its practice requires not only scientific knowledge, but also interpersonal,
intellectual and technical abilities and skills. This means a composition of knowledge, clinical
work and interpersonal communication. Communication is a vital element in Nursing in all areas
of activity and in all its interventions such as prevention, treatment, therapy, rehabilitation,
education and health promotion.
Nurses who communicate effectively are better able to collect assessment data, initiate
interventions, evaluate outcomes of interventions, initiate change that promotes health, and
prevent the safety and legal problems associated with nursing practice. The communication
process is built on a trusting relationship with a client and support people. Effective
communication is essential for the establishment of a nurse–client relationship.
SENDER
The sender, a person or group who wishes to communicate a message to another, can be
considered the source-encoder. This term suggests that the person or group sending the
message must have an idea or reason for communicating (source) and must put the idea or
feeling into a form that can be transmitted.
Encoding involves the selection of specific signs or symbols (codes) to transmit the message,
such as which language and words to use, how to arrange the words, and what tone of voice
and gestures to use.
MESSAGE
The second component of the communication process is the message itself—what is actually
said or written, the body language that accompanies the words, and how the message is
transmitted. The method used to convey the message can target any of the receiver’s senses. It
is important for the method to be appropriate for the message, and it should help make the
intent of the message clearer.
RECEIVER
The receiver, 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 sender
intended (interpretation).
Perception uses all the senses to receive verbal and nonverbal messages. To decode means to
relate the message perceived to the receiver’s storehouse of knowledge and experience and to
sort out the meaning of the message.
Whether the message is decoded accurately by the receiver, according to the sender’s intent,
depends largely on their similarities in knowledge and experience and sociocultural background.
If the meaning of the decoded message matches the intent of the sender, then the
communication has been effective.
Ineffective communication occurs when the receiver misinterprets the sent message.
RESPONSE
The fourth component of the communication process, the response, is the message that the
receiver returns to the sender. It is also called feedback. Feedback can be either verbal,
nonverbal, or both. Nonverbal examples are a nod of the head or a yawn. Either way, feedback
allows the sender to correct or reword a message.
MODES OF COMMUNICATION
Communication is generally carried out in two different modes: verbal and nonverbal.
Verbal communication uses the spoken or written word; nonverbal communication uses
other forms, such as gestures or facial expressions, and touch.
VERBAL COMMUNICATION
Verbal communication is largely conscious because people choose the words they use. The
words used vary among individuals according to culture, socioeconomic background, age, and
education.
Nurses need to consider the following when choosing words to say or write: pace and
intonation, simplicity, clarity and brevity, timing and relevance, adaptability, credibility, and
humor.
PACE AND INTONATION The manner of speech, as in the rate or rhythm and tone, will modify
the feeling and impact of a message. The tone of words can express enthusiasm, sadness,
anger, or amusement. The rate of speech may indicate interest, anxiety, boredom, or fear.
SIMPLICITY - includes the use of commonly understood words, brevity, and completeness.
Nurses need to learn to select appropriate, understandable, and simple terms based on the age,
knowledge, culture, and education of the client.
CLARITY AND BREVITY A message that is direct and simple will be effective. Clarity is saying
precisely what is meant, and brevity is using the fewest words necessary.
TIMING AND RELEVANCE No matter how clearly or simply words are stated or written, the
timing needs to be appropriate to ensure that words are heard. Moreover, the messages need
to relate to the person or to the person’s interests and concerns.
ADAPTABILITY The nurse needs to alter spoken messages in accordance with behavioral
cues from the client. This adjustment is referred to as adaptability. What the nurse says and
how it is said must be individualized and carefully considered. This requires astute assessment
and sensitivity on the part of the nurse.
CREDIBILITY means worthiness of belief, trustworthiness, and reliability. Credibility may be the
most important criterion of effective communication. Nurses foster credibility by being
consistent, dependable, and honest. The nurse needs to be knowledgeable about what is being
discussed and to have accurate information.
HUMOR The use of humor can be a positive and powerful tool in the nurse–client relationship,
but it must be used with care. Humor can be used to help clients adjust to difficult and painful
situations. The physical act of laughter can be an emotional and physical release, reducing
tension by providing a different perspective and promoting a sense of well-being.
When using humor, it is important to consider the client’s perception of what is considered
humorous. Timing is also important to consider. Though humor and laughter can help reduce
stress and anxiety, the feelings of the client need to be considered.
NONVERBAL COMMUNICATION
ELECTRONIC COMMUNICATION
Computers are playing an increasing role in nursing practice. Many health care agencies are
moving toward electronic medical records where nurses document their assessments and
nursing care. Electronic mail (e-mail) can be used in health care facilities for many purposes: to
schedule and confirm appointments, report normal lab results, conduct client education, and for
follow-up with discharged clients.
Many factors influence the communication process. Some of these are development, gender,
values and perceptions, personal space, territoriality, roles and relationships, environment,
congruence, interpersonal attitudes, and boundaries.
A. Development: Knowledge of a client’s developmental stage will allow the nurse to modify
the message accordingly.
B. Gender: From an early age, females and males communicate differently. Girls tend to
use language to seek confirmation, minimize differences, and establish intimacy. Boys
use language to establish independence and negotiate status within a group. These
differences can continue into adulthood.
C. Values and Perceptions- Values are the standards that influence behavior, and
perceptions are the personal view of an event. Because each person has unique
personality traits, values, and life experiences, each will perceive and interpret
messages and experiences differently.
D. Personal space is the distance people prefer in interactions with others. Proxemics is the
study of distance between people in their interactions.
Communication thus alters in accordance with four distances, each with a close and a
far phase. Beebe, Beebe, and Redmond (2014, p. 202) list the following examples:
1. Intimate: 0 to 1.5 feet
2. Personal: 1.5 to 4 feet
3. Social: 4 to 12 feet
4. Public: 12 feet and beyond.
BARRIERS TO COMMUNICATION
Communication is an integral part of the nursing process. Nurses use communication skills in
each phase of the nursing process. Communication is also important when caring for clients
who have communication problems. Communication skills are even more important when the
client has sensory, language, or cognitive deficits.
NURSING MANAGEMENT
Assessing
Impairments to Communication
Various barriers may alter a client’s ability to send, receive, or comprehend messages. These
include language deficits, sensory deficits, cognitive impairments, structural deficits, and
paralysis. The nurse must assess each client to determine the presence of barriers.
Style of Communication
In assessing communication style, the nurse considers both verbal and nonverbal
communication. In addition to physical barriers, some psychological illnesses (e.g., depression
or psychosis) influence the ability to communicate.
Diagnosing
Communication problems may be receptive (e.g., difficulty hearing) or expressive (e.g., difficulty
speaking). The nursing diagnosis Impaired Verbal Communication may not be useful when an
individual’s communication problems are caused by a psychiatric illness.
If the communication issue is due to the client having a problem coping, the diagnoses of Fear
or Anxiety may be more appropriate. Other NANDA nursing diagnoses (Herdman & Kamitsuru,
2014) used for clients experiencing communication problems that involve impaired verbal
communication as the etiology could include the following:
Planning
When a nursing diagnosis related to impaired verbal communication has been made, the nurse
and client determine outcomes and begin planning ways to promote effective communication.
The overall client outcome for individuals with Impaired Verbal Communication is to reduce or
resolve the factors impairing the communication.
Implementing
Nursing interventions to facilitate communication with clients who have problems with speech or
language include manipulating the environment, providing support, employing measures to
enhance communication, and educating the client and support person.
Evaluating
Evaluation is useful for both client and nurse communication. To establish whether client
outcomes have been met in relation to communication, the nurse must listen actively, observe
nonverbal cues, and use therapeutic communication skills to determine that communication was
effective.
References:
Kozier and Erbs Fundamentals of Nursing, Concepts, Process and Practice, 10th edition
https://www.rivier.edu/academics/blog-posts/17-therapeutic-communication-techniques/
https://www.registerednursing.org/nclex/therapeutic-communication/
http://samples.jbpub.com/9781449691776/9781449691776_CH05_Pass2.pdf
POST TEST
I. Read the following statements carefully. Match Column A with the correct
answer on Column B. Write only the letter of your choice before each number.
II. Read the statements carefully. Write “T” if the statement is therapeutic and
“NT” if the statement is non therapeutic on the space before each number.
______1. “Perhaps you would like to talk about. . . .”
_______2. “How have you been feeling lately?”
_______3. “Men don’t cry.”
_______4. “I don’t want to discuss that. Let’s talk about. . . .”
_______5. “I’m sure everything will turn out all right.”
_______6. “Would you tell me more?”
_______7. “I notice you keep squinting your eyes. Are you having difficulty seeing?”
_______8. “During the past half hour we have talked about. . . .”
_______9. “You shouldn’t do that.”
_______10. Nurse: “Why were you speeding?”
III. Identify the following techniques of communication (therapeutic technique and
Non therapeutic technique) based on the written statements/ examples. Write
your answer on the space provided.
Example:
Using silence Sitting quietly (or walking with the client) and waiting attentively until the client is
able to put thoughts and feelings into words.
________1. Directing the communication into areas of self-interest rather than considering the
client’s concerns.
________2. Asking for information chiefly out of curiosity rather than with the intent to assist the
client
________3. Giving opinions and approving or disapproving responses, moralizing, or implying
one’s own values
________4. Telling the client what to do.
________5. Attempting to protect a person or health care services from negative comments
________6. This technique is useful at the end of an interview or to review a health teaching
session and often acts as an introduction to future care planning.
________7. Actively listening for the client’s basic message and then repeating those thoughts
and/or feelings in similar words
________8. Making statements that are specific rather than general, and tentative rather than
absolute
________9. Suggesting one’s presence, interest, or wish to understand the client without
making any demands
________10. Helping the client to differentiate the real from the unreal.