Chapter 6 MH

exchange of information
verbal and nonverbal

content: literal words spoken
context: environment, circumsatances, situation in which communication occyrs

process: all messages used to give meaning, context to message
congruent and incongruent messages

conveyed when content and process agree

when what the speaker and their behavior do not agree

interpersonal interactions
focus on client's needs
need for privacy
enxompasses goals that facilitate the nursing process
needed to effectively meet the standard of client care

Establish therapeutic nurse-client relationship
Identify the most important client concern; assess client's perceptions
Facilitate client's expression of emotions
Teach client and family the necessary self care skills
Recognize client's needs
Implement interventions to address client's need
Guide client toward acceptable solutions

intimate (0-18 in) "our bubbles"
personal (18-36 in)
social (4-12 ft)
public (12-25 ft)

nurse and patient are 3 to 6 ft apart

functional -> professional
social -> polite
friendship -> warmth
love -> intimacy
sexual -> arousal

comforting and supportive when welcome and permitted
can be possible invasion of intimate and personal space
the nurse must evaluate use of touch based on the client's preferences, history and needs
nurse may find touch supportive and client may not

refraining from other internal mental activities and concentrating exclusively on what the client says

watching the speaker's nonverbal actions as they communicate

recognize the most important issue
know what questions to ask
use therapeutic communication techniques
prevent jumping to conclusions
objectviely respond to message

words are explicit and need no interpretation

unclear patterns of words that often contain figures of speech that are difficult to interpret
"wear your heart on your sleeve"

exploring
focusing
restating
reflecting

delving further into a subject or idea
"tell me more about that"

concentrating on a single point
"of all he concerns you've mentioned, which is most troublesome"

repeating the main idea expressed

directing client actions, thoughts and feelings back to client

some promote discussion of feelings or concern in more depth
other are useful for focusing or clarifying what is being said
feedback via making an observation or presenting reality

advising
belittling
challenging
probing
reassurance

telling the client what to do
"I think you should.."

misjudging the degree of the client's discomfort
"everyone feels down in the dumps"

demanding proof from the client

persistant questioning of the client

indicating there is no reason for anxiety or other feelings of discomfort
"everything will be alright"

clear, direct statements
ex: "I want to die"

vague, indirect messages
ex: "Nothing can help me"

Facial expressions (mean more than words smtimes)
Body language
Vocal cues

expressive -> moment bu moment thoughts, feelings and needs
impassive -> face is froxen into an emotionless deadpan expression similar to a mask
confusing -> one that is opposite of what the person wants to convey

closed body position -> interaction might threaten listener who is defensive and not accepting
open posture -> unconditional positive regard, trust, care and acceptance

voice volume, tone, pitch, intensity, emphasis, speed and pauses

looking into other person's eyes during conversation

can indicate the client is thoughtfully considering questions
OR lost in their own thoughts

messages often contain more meaning that just words spoken

validation of client finding from verbal and nonverbal information
assessment focuses on who, what, when, how, and why

belief about life, health, illness, death, and one's relationship to the universe

assess their own spiritual and religious beliefs
remain objective and nonjudgmental
assess client' spiritual and religious needs
be aware of and respect client's beliefs

cultural assessment
use of a translator who can retain original intent without inserting biases **important**
nurse must understand differences in how various cultures communicate

establishing rapport
actively listening -> not thinking of what you're going to say
gaining in-depth understanding of client's perception of issue
being empathetic -> single most important thing we can do to develop therapeutic relationship
exploring client's thoughts and feelings
facilitating client's expression of thoughts and feelings
guiding client in developing problem-solving skills
promoting client's evaluation of solutions

introduction
establisment of contract or relationship
learning how client prefers to be addressed
identification of major concern

broad openings, open-ended questions
help client identify and discuss topic of concern

direct yes-or-no questions
usually for clients with suicidal thoughts, in crisis, or who are out of touch with reality

help the client explore possibilities
client's participtation is key
avoid inserting own beliefs

expression of positive and negative feelings/ ideas in an open, honest, direct way
calm, specific, factual statement s
focus on "I" statements -> "I feel" "I think"

aggressive -> "Are you always this dirty?"
passive-aggressive
passive
assertive

repeats response without justifying or explaining response
may have to rehearse responses bc takes practice

nonverbal communication is as important as verbal communication
awareness of own communication is the first step toward improving communication
ask for feedback from colleagues and examine own communication skills