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Rachel Natividad, RN, MSN, NP. Have you ever been nailed by nasty remarks from a hostile friend, family member, or stranger? Ever been bashed by comments and criticisms from colleagues? How did you react? Did you gracefully defuse the situation?. Communication. Communication defined….

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Have you ever been nailed by nasty remarks from a hostile friend, family member, or stranger?

Ever been bashed by comments and criticisms from colleagues?

How did you react?

Did you gracefully defuse the situation?

communication defined
Communication defined…
  • “The exchange of information which involves both sending and receiving messages between two or more people…”.(Timby, 2005)
  • “The process of sending and receiving messages by means of symbols, words, signs, gestures, or other actions”. (Smith, Duell, & Martin, 2004)
Describe a situation in which you did not communicate effectively and the result.
  • What could you have done differently?
effective communication in nursing
Effective Communication in Nursing

Increases patient satisfaction and health outcomes

Decreases risk of complaints and litigation

Increases level of job satisfaction

elements of communication
Elements of Communication
  • Sender
  • Message
  • Receiver
  • Feedback
  • Meaning (sender/receiver)
Language is inherently ambiguous…

Communication can be confusing!!!

Ambiguous Picture

communication patterns
Communication Patterns
  • Verbal
  • Tone
  • Nonverbal
    • Facial expressions
    • Gestures
    • Eye contact
    • Body language





Nonverbal 55%

communication in nursing
Communication in Nursing
  • Nurse-client relationship - Therapeutic Relationship-
  • Client-centered
phases of therapeutic relationship
Phases of Therapeutic Relationship
  • Introductory phase - initiation or orientation phase
  • Working phase– facilitating the relationship
  • Termination phase– relationship comes to an end
case study resolution the first encounter
Case Study Resolution: The First Encounter
  • Attempt to identify the source of hostility
  • Allow client to verbalize feelings, fears, concerns
  • Offer explanations and explain the purpose of the procedures/medications.
case study resolution the first encounter1
Case Study Resolution: The First Encounter

Acceptable responses:

  • “You sound upset this morning.”
  • “Mrs. T, it is difficult to be a patient. You haven’t had much time to yourself.”
  • “When would you like me to bring your medicine?”

A poem by….


blocks to therapeutic communication
Changing the subject

False reassurance

Giving advice





Social Response


Value judgements

Blocks to Therapeutic Communication


therapeutic communication techniques




Incomplete sentences


Mutual fit or congruence

Minimum verbal activity

Nonverbal encouragement

Open-ended questions




Therapeutic Communication Techniques
cultural diversity
Cultural Diversity
  • Slang terms and colloquialisms
  • Stress of illness – different meanings in various cultures
  • Eye contact, touch personal space – meanings vary among cultures
let s communicate transculturally
Assess language needs

Approach patient slowly and greet her/him respectfully

Do not raise your voice to be heard

Allow sufficient time and a quiet setting

Pay attention to nonverbals

Try to mirror pt’s style of communicating

Provide written material in patient’s language if available

Let’s Communicate Transculturally!
are you culturally competent
Are you culturally competent?
  • “…learn the language that a majority of your clients speak – this will give you insight into the culture…”(Gaskill, 2002)
  • Greet or say words and phrases in the client’s language
case study resolution cultural diversity
Case Study Resolution: Cultural Diversity
  • Recognize impact of the client’s culture to communication style, health care and practices/beliefs
  • Consider cultural roots when continuing with the plan of care
anxiety and communication
Anxiety and Communication
  • How can stress/anxiety affect your communication with your clients?
  • How can stress affect client’s communication with you?
  • What techniques do you use to decrease your stress routinely? During exams?






Levels of Anxiety

Communication Styles

a confrontation with ms madd
A confrontation with Ms. Madd
  • You have just finished the change of shift report when Mrs. K confronts you at the nurses station. Due to a serious fall, Mrs. K’s sister M.L has sustained a cervical fracture that, in spite of numerous efforts, has not yet been stabilized. During the past few days…….(retrieved from 1/20/05)
help the anxious client
Be alert to s/s of anxiety

Assist pt to verbalize feelings and concerns and try to ID source of anxiety

Be understanding of pt’s feelings

Avoid becoming tense or defensive

Speak slowly and briefly, avoid empty phrases that does not help the situation

Offer explanations of info if pt has misconceptions about the situation

Assess the patient’s support system

ID previously useful coping mechanisms

Help the anxious client

Rather than just defend yourself and face the same problems over and over like Wiley Coyote, say what you are really feeling!

Ask for help when you need it!

  • Timby, B. K. (2005). Fundamentals Nursing Skills and Concepts. 8th Ed. Lippincott Williams & Wilkins: Philadelphia, PA
  • Smith, S.F., Duell, D.J., & Martin, B. C., (2004). Clinical Nursing Skills: Basic to Advanced Skills. 6th Ed. Pearson Education Inc.: Upper Saddle River, NJ.
  • Sheldon, L.K. (2004). Communication for Nurses: Talking with Patients. Slack Inc: Thorofare, NJ.