Far Eastern University

Institute of Nursing

NUR1204 Fundamentals of Nursing

Discussion Proper

Communicating (day 3 & 4)

1. Process and Modes

a. Nine Elements of Communication
b. Six Levels of Human Communication
c. Five Types of Communication
2. Therapeutic Communication

a. Goals of Therapeutic Communication

b. Verbal Communication Skills

c. Non Verbal Communication Skills

d. Therapeutic Communication

e. Barriers to Effective Communication

f. Non Therapeutic Communication

3. Helping Relationship
a. Phases of the Helping Relationship
b. Factors Promoting Effective Communication within the Helping Relationship
4. Communication and the Nursing Process
a. Rapport Builders that Promotes Effective Communication
b. Guidelines when communicating with clients
c. Focus of therapeutic communication
d. Therapeutic Nursing Process
Process and Modes

Nine Elements of Communication

Communication is an integral part of life and from your personal life to your workplace as well as in
public life, effective communication helps you connect with others with higher convenience and success.
In the field of business and marketing also, communication has definite and major importance. People
come across various forms of communication in daily life. Some of these are personal and some meant for
everyone. However, every piece of communication aims to achieve some end. It is why to make your
communication effective, it is important to understand the various elements of communication. It is even
important for the marketers since by knowing these elements, they can craft more effective messages that
will help them obtain the desired response from their audience.

1. Sender: The sender is the person who is initiating the communication or sending the
message. It can be a person or a party like a company. For example, if a company is
advertising its products, it is the sender communicating with its target audience. The
sender and the receiver are the major parties involved in communication. In the case of
internal communication, a manager may be sending an email to his subordinate where the
manager is the sender.

2. Encoding: It is the process of assembling symbols to communicate the message or

simply put the process of putting thought into a symbolic form. People use words and
images to convey their intended message. For example, an advertisement for an HP
laptop includes words and illustrations. The process of encoding can also be understood
as composing an email or creating an advertisement for mass display.

3. Message: It is the set of symbols that the sender transmits or the content of the
communication. A piece of communication may include only words or words and
graphics or even a piece of multimedia. You come across several advertisements daily
and many of them are filled with illustrations and words. The ad itself is the message.

4. Media: is the channel of communication that is used to transmit the message. In the case
of verbal communication, you might be using a phone or talking to the receiver directly.
In the case of a written message, you can use an email or some chat tool like WhatsApp.
Companies also communicate internally and externally and use various forms of
communication channels. Since advertisements are also forms of communication, the
channel used to transmit the ad is the media. An ad can be transmitted through television
or newspapers and magazines or placed outdoors. Magazines, newspapers, television, etc
are the media used to communicate with the audience or the receivers.
5. Decoding: It is the process of interpreting the message or the process by which the
receiver assigns meaning to the symbols in a message. Decoding is the opposite of
encoding. For example, when you read an email, you are decoding the message in it.
When a person reads an advertisement or watches it, he decodes the message included in
the advertisement.

6. Receiver: A receiver is the second party involved in the process of communication.

There can be several receivers of the same message. A marketing manager sends a
proposal to a customer and he reads it. The customer is the receiver of the message.
Similarly, when a person reads an advertisement for an HP laptop, he is the receiver.
There can be several receivers of the same message. Several people may come across and
read the same advertisement.

7. Response: It is the reaction of the receiver decoding the message. Once a receiver is
exposed to a message, there are several possible responses. For example, when you see
an ad, you may feel excited to know more about the product, your awareness of that
brand might grow or you may even think of buying it or actually buy it. In some cases,
there may be no reaction and you may remain indifferent to the message and not give any
reaction. There are hundreds of possible responses to a message. This is why marketers
try to create persuasive messages that may persuade their audience to like or buy the
product.

8. Feedback: It is that part of the receiver’s response which is communicated back to the
sender. For example, after seeing the ad for the HP laptop, you may feel satisfied and buy
it. You may remember the ad and call or write to the company to praise the manufacturer
for such a beautiful product. If you have a bad experience, you may also write or call to
criticize those aspects of the product which you hate. Marketers also create feedback
forms to know the reaction of their audience about their advertisements and other forms
of marketing communication and to know how memorable or effective the message was.

9. Noise: Noise is not a part of the planned communication. It can erupt from other sources
and mesh the receiver’s decoding of the message. Noise is the unplanned distortion
during the process of communication which may cause the receiver to receive a different
message than the intended one. For example, you saw a beautiful ad in a magazine but
got distracted and missed the product features or the other key points of the
advertisement. Sometimes, there are too many ads on the same page and that can also
cause the receiver to become distracted leading to the person not paying enough attention
to an ad and the central message getting lost in the noise caused by overcrowding of ads.
There are too many brands in the market and the one that wants to stand out should create
 an ad that would catch and sustain the audience’s attention. Otherwise, there is just so
much noise that people would forget your brand and product.

Six Levels of Human Communication

1. Intra-personal: self -talk and identity formation

2. Interpersonal: two people interacting
3. Small Group: three to twelve (plus or minus three) people interacting for a common
purpose.
4. Public Communication: one person speaking to an audience.
5. Organizational Communication: members of an large group (business,
church, interest group) interacting with each other and outside world.
6. Mass Communication: one source communicating to a large
audience through media(radio, television, internet, newspapers, books).

Five Types of Communication

1. Verbal Communication: Verbal communication occurs when we engage in speaking

with others. It can be face-to-face, over the telephone, via Skype or Zoom, etc. Some
verbal engagements are informal, such as chatting with a friend over coffee or in the
office kitchen, while others are more formal, such as a scheduled meeting. Regardless of
the type, it is not just about the words, it is also about the caliber and complexity of those
words, how we string those words together to create an overarching message, as well as
the intonation (pitch, tone, cadence, etc.) used while speaking. And when occurring face-
to-face, while the words are important, they cannot be separated from non-verbal
communication.
2. Non-Verbal Communication: What we do while we speak often says more than the
actual words. Non-verbal communication includes facial expressions, posture, eye
contact, hand movements, and touch. For example, if you’re engaged in a conversation
with your boss about your cost-saving idea, it is important to pay attention to both the
their words and their non-verbal communication. Your boss might be in agreement with
your idea verbally, but their nonverbal cues: avoiding eye contact, sighing, scrunched up
face, etc. indicate something different.

3. Written Communication: Whether it is an email, a memo, a report, a Facebook post, a

Tweet, a contract, etc. all forms of written communication have the same goal to
disseminate information in a clear and concise manner – though that objective is often
not achieved. In fact, poor writing skills often lead to confusion and embarrassment, and
even potential legal jeopardy. One important thing to remember about written
communication, especially in the digital age, is the message lives on, perhaps in
perpetuity. Thus, there are two things to remember: first, write well – poorly constructed
sentences and careless errors make you look bad; and second, ensure the content of the
message is something you want to promote or be associated with for the long haul.
 4. Listening: The act of listening does not often make its way onto the list of types of
communication. Active listening, however, is perhaps one of the most important types of
communication because if we cannot listen to the person sitting across from us, we
cannot effectively engage with them. Think about a negotiation – part of the process is to
assess what the opposition wants and needs. Without listening, it is impossible to assess
that, which makes it difficult to achieve a win/win outcome.

5. Visual Communication: We are a visual society. Think about it, televisions are running
24/7, Facebook is visual with memes, videos, images, etc., Instagram is an image-only
platform, and advertisers use imagery to sell products and ideas. Think about from a
personal perspective – the images we post on social media are meant to convey meaning
– to communicate a message. In some cases that message might be, look at me, I’m in
Italy or I just won an award.

Therapeutic Communication

Communication is the process that people use to exchange information; messages are simultaneously
sent and received on two levels: verbally through the use of words and nonverbally by behaviors that
accompany the words.

• Therapeutic communication is an interpersonal interaction between the nurse and the client
during which the nurse focuses on the client’s specific needs to promote an effective exchange of
information.
• Skilled use of therapeutic communication techniques helps the nurse understand and empathize
with the client’s experience.

Goals of Therapeutic Communication

Therapeutic communication can help nurses to accomplish many goals:

• Establish a therapeutic nurse-client relationship.

• Identify the most important client concern at that moment (the client-centered goal).
• Assess the client’s perception of the problem as it unfolds; this includes detailed actions
(behaviors and messages) of the people involved and the client’s thoughts and feelings about the
situation, others, and self.
• Facilitate the client’s expression of emotion.
• Teach the client and the family necessary self-care skills.
• Recognize the client’s needs.
• Implement interventions designed to address the client’s needs.
• Guide the client toward identifying the plan of action to a satisfying and socially acceptable
resolution.

Verbal Communication Skills

Verbal communication consists of the words a person uses to speak to one or more listeners.

• Using concrete messages. The nurse should use words that are as clear as possible when
speaking to the client so that the client can understand the message; in a concrete message, the
words are explicit and need no interpretation, the speaker uses nouns instead of pronouns;
concrete questions are clear, direct, and easy to understand.
• Using therapeutic communication techniques. The choice of technique depends on the intent of
the interaction and the client’s ability to communicate verbally; overall, the nurse selects
techniques that facilitate the interaction and enhance communication between client and nurse.
• Avoiding non-therapeutic communication. In contrast, there are many non-therapeutic
techniques that nurses should avoid; these responses cut off communication and make it more
difficult for the interaction to continue.
• Interpreting signals or cues. To understand what a client means, the nurse watches and listens
carefully for cues; cues are verbal or nonverbal messages that signal keywords or issues for the
client; finding cues is a function of active listening often, cue words introduced by the client can
help the nurse to know what to ask next or how to respond to the client.

Nonverbal Communication Skills

Nonverbal communication is behavior that a person exhibits while delivering verbal content.

• Facial expression. The human face produces the most visible, complex, and sometimes
confusing nonverbal messages; facial movements connect with words to illustrate meaning; this
connection demonstrates the speaker’s internal dialogue.
• Body language. Body language (gestures, postures, movements, and body positions) is a
nonverbal form of communication; closed body positions, such as crossed legs or arms folded
across the chest, indicate that the interaction might threaten the listener who is defensive or not
accepting; a better, more accepting body position is to sit facing the client with both feet on the
floor, knees parallel, hands at the side of the body, and legs uncrossed or crossed only at the
ankle.
• Vocal cues. Vocal cues are nonverbal sound signals transmitted along with the content: voice
volume, tone, pitch, intensity, emphasis, speed, and pauses augment the sender’s message;
volume, the loudness of the voice, can indicate anger, fear, happiness, or deafness; tone can
indicate whether someone is relaxed, agitated, or bored; pitch varies from shrill and high to low
and threatening; intensity is the power, severity and strength behind the words; emphasis refers to
accents on words or phrases that highlight the subject; and speed is the number of words spoken
per minute.
• Eye contact. The eyes have been called the mirror of the soul because they often reflect our
emotions; eye contact, looking into the other person’s eyes during communication, is used to
assess the other person and the environment and to indicate whose turn it is to speak; it increases
during listening but decreases while speaking.
Therapeutic Communication Techniques

Choosing the appropriate therapeutic communication technique is critical in establishing and

maintaining the nurse-patient relationship. These techniques are discussed below:

Therapeutic Communication
Examples Rationale
Technique

“Yes.”
An accepting response indicates the
Accepting. “I follow what you
nurse has heard and followed the
Indicating reception said.”
train of thought.
Nodding

“Is there something

Broad openings.
Allowing the client to take the
initiative in introducing the topic.
Consensual validation.
Searching for mutual
understanding, for accord in the
meaning of the words.
you’d like to talk
about?” Broad openings make explicit that the
client has the lead in the interaction.
“Where would you like
to begin?”
For verbal communication to be
“Tell me whether my
meaningful, it is essential that the
understanding of it
words being used have the same
agrees with yours.”
meaning for both (all) participants.

Encouraging comparison.
Asking that similarities and
differences be noted.
Encouraging description of
prescriptions.
Asking the client to verbalize what
he or she perceives.
“Was it something
like…?” Comparing ideas, experiences, or
relationships brings out many
Have you had similar recurrent themes.
experiences?
“Tell me when you feel
anxious.”
To understand the client, the nurse
“What is happening?”
must see things from his or her
perspective.
“What does the voice
seem to be saying?”

“What are your

Encouraging expression. Asking
the client to appraise the quality of
his or her experiences.
Exploring.
Delving further into a subject or
idea.
Focusing.
Concentrating on a single point.
feelings in regard to..?” The nurse asks the client to consider
people and events in light of his or her
“Does this contribute to own values.
your distress?”
“Tell me more about
that.” When clients deal with topics
superficially, exploring can help them
“Would you describe it examine the issue more fully.
more fully?”
“This point seems The nurse encourages the client to
worth looking at more concentrate his or her energies on a
 closely.” single point, which may prevent a
multitude of factors or problems from
overwhelming the client.

Formulating a plan of action.

“What could you do to It may be helpful for the client to plan
Asking the client to consider kinds
let your anger out in advance what he or she might do in
of behavior likely to be appropriate
harmlessly?” future similar situations.
in future situations.

General leads indicate that the nurse

General leads. “Go on.” is listening and following what the
Giving encouragement to continue. client is saying without taking away
“And then?” the initiative for interaction.

Giving information. Making
available the facts that the client
needs.
Giving recognition.
Acknowledging, indicating
awareness.
“My name is…” Informing the client of facts increases
his or her knowledge about a topic or
“Visiting hours are…” lets the client know what to expect.
Greeting the client by name, indicating
“Good morning Mr…” awareness of change, or noting efforts
the client has made all show that the
“You’ve finished your nurse recognizes the client as a
list of things to do.” person, as an individual.

Making observations. “You appear tense.”

Verbalizing what the nurse
perceives.
Offering self.
Making oneself available.
Sometimes client cannot verbalize or
make themselves understood.
“Are you uncomfortable
when..?”
The nurse can offer his or her
“I’ll sit with you
presence, interest, and desire to
awhile.”
understand.

Placing event in time or

Putting events in proper sequence
sequence. “What seemed to lead
helps both the nurse and client to see
Clarifying the relationship of events up to…?”
them in perspective.
in time.

Presenting reality. When it is obvious that the client is

“I see no one else in
Offering for consideration that misinterpreting reality, the nurse can
the room.”
which is real. indicate what is real.

Client: “Do you think I

Reflecting. should tell the doctor?” Reflection encourages the client to
Directing client actions, thoughts, recognize or accept his or her own
and feelings back to client. Nurse: “Do you think feelings.
you should?”
Restating. Client: “I can’t sleep. I
The nurse repeats what the client has
Repeating the main idea expressed. stay awake all night.” said in approximately or nearly the
Nurse: “You have

Seeking information. Seeking to
make clear that which is not
meaningful or that which is vague.
Silence. Absence of verbal
communication, which provides
time for the client to put thoughts or
feelings into words, to regain
composure, or to continue talking.
Suggesting collaboration. Offering
to share, to strive, to work with the
client for hi or her benefit.
Summarizing. Organizing and
summing up that which has gone
before.
Translating into feelings. Seeking
to verbalize client’s feelings that he
or she expresses only indirectly.
Verbalizing the implied. Voicing
what the client has hinted or
suggested.
Voicing doubt. Expressing
uncertainty about the reality of the
client’s perception.
Other Therapeutic Communication
1. Offering Self
• Making self-available and showing interest and concern.
• “I will walk with you”
2. Active listening
• Paying close attention to what the patient is saying by observing both verbal and non-verbal cues.
difficulty sleeping.” same words the client has used.
“I’m not sure that I The nurse should seek clarification
follow.” through interactions with clients.
Nurse says nothing but
Silence often encourages the client to
continues to make eye
verbalize, provided that it is
contact and conveys
interested and expectant.
interest.
The nurse seeks to offer a relationship
“Perhaps you and I can
in which the client can identify
discuss and discover
problems in living with others, grow
the triggers for your
emotionally, and improve the ability
anxiety.”
to form satisfactory relationships.
Summarization seeks to bring out the
“Have I got this important points of the discussion and
straight?” to increase the awareness and
understanding of both participants.
Client: “I’m dead.”
Often what the client says, when taken
Nurse: “Are you
literally, seems meaningless or far
suggesting that you feel
removed from reality.
lifeless?”
Client: “I can’t talk to
you or anyone. It’s a Putting into words what the client has
waste of time.” implied or said indirectly tends to
make the discussion less obscure.
Nurse: “Do you feel that
no one understands?”
“Isn’t that unusual?” Another means of responding to
distortions of reality is to express
“Really?” doubt.
 • Maintaining eye contact and making verbal remarks to clarify and encourage further
communication.

3. Exploring

• “Tell me more about your son”

4. Giving broad openings

• What do you want to talk about today?

5. Silence

• Planned absence of verbal remarks to allow patient and nurse to think over what is being
discussed and to say more.

6. Stating the observed

• verbalizing what is observed in the patient to, for validation and to encourage discussion
• “You sound angry”

7. Encouraging comparisons

• · asking to describe similarities and differences among feelings, behaviors, and events.
• · “Can you tell me what makes you more comfortable, working by yourself or working as a
member of a team?”

8. Identifying themes

• Asking to identify recurring thoughts, feelings, and behaviors.

• “When do you always feel the need to check the locks and doors?”

9. Summarizing

• Reviewing the main points of discussions and making appropriate conclusions.

• “During this meeting, we discussed about what you will do when you feel the urge to hurt your
self again and this include…”

10. Placing the event in time or sequence

• Asking for relationship among events.

• “When do you begin to experience this ticks? Before or after you entered grade school?”

11. Voicing doubt

• Voicing uncertainty about the reality of patient’s statements, perceptions and conclusions.
• “I find it hard to believe…”

12. Encouraging descriptions of perceptions

 • Asking the patients to describe feelings, perceptions and views of their situations.
• “What are these voices telling you to do?”

13. Presenting reality or confronting

• Stating what is real and what is not without arguing with the patient.
• “I know you hear these voices but I do not hear them”.
• “I am Lhynnelli, your nurse, and this is a hospital and not a beach resort.

14. Seeking clarification

• Asking patient to restate, elaborate, or give examples of ideas or feelings to seek clarification of
what is unclear.
• “I am not familiar with your work, can you describe it further for me”.
• “I don’t think I understand what you are saying”.

15. Verbalizing the implied

• Rephrasing patient’s words to highlight an underlying message to clarify statements.

• Patient: I won’t be bothering you anymore soon.
• Nurse: Are you thinking of killing yourself?

16. Reflecting

• Throwing back the patient’s statement in a form of question helps the patient identify feelings.
• Patient: I think I should leave now.
• Nurse: Do you think you should leave now?

17. Restating

• Repeating the exact words of patients to remind them of what they said and to let them know they
are heard.
• Patient: I can’t sleep. I stay awake all night.
• Nurse: You can’t sleep at night?

18. General leads

• Using neutral expressions to encourage patients to continue talking.

• “Go on…”
• “You were saying…”

19. Asking question

• Using open-ended questions to achieve relevance and depth in discussion.

• “How did you feel when the doctor told you that you are ready for discharge soon?”

20. Empathy

• Recognizing and acknowledging patient’s feelings.

 • “It’s hard to begin to live alone when you have been married for more than thirty years”.

21. Focusing

• Pursuing a topic until its meaning or importance is clear.

• “Let us talk more about your best friend in college”
• “You were saying…”

22. Interpreting

• Providing a view of the meaning or importance of something.

• Patient: I always take this towel wherever I go.
• Nurse: That towel must always be with you.

23. Encouraging evaluation

• Asking for patients views of the meaning or importance of something.

• “What do you think led the court to commit you here?”
• “Can you tell me the reasons you don’t want to be discharged?

24. Suggesting collaboration

• Offering to help patients solve problems.

• “Perhaps you can discuss this with your children so they will know how you feel and what you
want”.

25. Encouraging goal setting

• Asking patient to decide on the type of change needed.

• “What do you think about the things you have to change in your self?”

26. Encouraging formulation of a plan of action

• Probing for step by step actions that will be needed.

• “If you decide to leave home when your husband beat you again what will you do next?”

27. Encouraging decisions

• Asking patients to make a choice among options.

• “Given all these choices, what would you prefer to do.

28. Encouraging consideration of options

• Asking patients to consider the pros and cons of possible options.

• “Have you thought of the possible effects of your decision to you and your family?”

29. Giving information

• Providing information that will help patients make better choices.

 • “Nobody deserves to be beaten and there are people who can help and places to go when you do
not feel safe at home anymore”.

30. Limit setting

• Discouraging nonproductive feelings and behaviors, and encouraging productive ones.

• “Please stop now. If you don’t, I will ask you to leave the group and go to your room.

31. Supportive confrontation

• Acknowledging the difficulty in changing, but pushing for action.

• “I understand. You feel rejected when your children sent you here but if you look at this way…”

32. Role playing

• Practicing behaviors for specific situations, both the nurse and patient play particular role.
• “I’ll play your mother, tell me exactly what would you say when we meet on Sunday”.

33. Rehearsing

• Asking the patient for a verbal description of what will be said or done in a particular situation.
• “Supposing you meet these people again, how would you respond to them when they ask you to
join them for a drink?”.

34. Feedback

• Pointing out specific behaviors and giving impressions of reactions.

• “I see you combed your hair today”.

35. Encouraging evaluation

• Asking patients to evaluate their actions and their outcomes.

• “What did you feel after participating in the group therapy?”.

36. Reinforcement

• Giving feedback on positive behaviors.

• “Everyone was able to give their options when we talked one by one and each of waited patiently
for our turn to speak”.

Barriers to Effective Communication:

1. Giving advise
2. Talking about your self
3. Telling client is wrong
4. Entering into hallucinations and delusions of client
5. False reassurance
6. Cliché
7. Giving approval
 8. Asking WHY?
9. Changing subject
10. Defending doctors and other health team members.

Non-therapeutic Technique/Communication

1. Overloading

• talking rapidly, changing subjects too often, and asking for more information than can be
absorbed at one time.
• “What’s your name? I see you like sports. Where do you live?”

2. Value Judgments

• giving one’s own opinion, evaluating, moralizing or implying one’s values by using words such
as “nice”, “bad”, “right”, “wrong”, “should” and “ought”.
• “You shouldn’t do that, its wrong”.

3. Incongruence

• sending verbal and non-verbal messages that contradict one another.

• The nurse tells the patient “I’d like to spend time with you” and then walks away.

4. Underloading

• remaining silent and unresponsive, not picking up cues, and failing to give feedback.
• The patient asks the nurse, simply walks away.

5. False reassurance/ agreement

• Using cliché to reassure client.

• “It’s going to be alright”.

6. Invalidation

• Ignoring or denying another’s presence, thought’s or feelings.

• Client: How are you?
• Nurse responds: I can’t talk now. I’m too busy.

7. Focusing on self

• responding in a way that focuses attention to the nurse instead of the client.
• “This sunshine is good for my roses. I have beautiful rose garden”.

8. Changing the subject

• introducing new topic

• inappropriately, a pattern that may indicate anxiety.
• The client is crying, when the nurse asks “How many children do you have?”
9. Giving advice

• telling the client what to do, giving opinions or making decisions for the client, implies client
cannot handle his or her own life decisions and that the nurse is accepting responsibility.
• “If I were you… Or it would be better if you do it this way…”

10. Internal validation

• making an assumption about the meaning of someone else’s behavior that is not validated by the
other person (jumping into conclusion).
• The nurse sees a suicidal clients smiling and tells another nurse the patient is in good mood.

Other ineffective behaviors and responses:

1. Defending – Your doctor is very good.

2. Requesting an explanation – Why did you do that?
3. Reflecting – You are not suppose to talk like that!
4. Literal responses – If you feel empty then you should eat more.
5. Looking too busy.
6. Appearing uncomfortable in silence.
7. Being opinionated.
8. Avoiding sensitive topics
9. Arguing and telling the client is wrong
10. Having a closed posture-crossing arms on chest
11. Making false promises – I’ll make sure to call you when you get home.
12. Ignoring the patient – I can’t talk to you right now
13. Making sarcastic remarks
14. Laughing nervously
15. Showing disapproval – You should not do those things.

Helping Relationship

Phases of the Helping Relationship:

1. Pre-interaction Phase

Before meeting a patient:

• Review available data (medical and nursing history)

• Talk to other caregivers who have info on the patient
• Anticipate health concerns or issues
• Identify a location/setting that fosters comfortable, private interaction
• Plan enough time for interaction

2. Orientation Phase

When the nurse and patient meet and get to know one another:

• Recognize the initial relationship is often uncertain (trust and rapport)

 • Expect the patient to test your competence
• Closely observe the patient and vice versa
• Assess the patient’s health status
• Assess patient’s strengths and weaknesses
• Prioritize the patient’s problems and identify their goals
• Environment should be therapeutic
• Help your patient to communicate

3. Working Phase

When the nurse and the patient work together to solve problems and accomplish goals:

• Encourage and help the patient express feelings about their health and self-exploration
• Take action to meet the goals (implement action plan)
• Use therapeutic communication skills to facilitate successful interactions
• Promote positive self concept and develop positive coping behaviors
• Plan a realistic goal setting
• Organize a support system
• Evaluate the results of plan action

4. Termination Phase

During the ending of the relationship:

• Promote self care

• Recognize increasing anxiety of the patient
• Increase independence
• Demonstrate emotional stability of the patient
• Environmental support

Factors Promoting Effective Communication within the Helping Relationship:

1. Warmth and Friendliness

2. Openness and Respect
3. Empathy
4. Honesty, Authenticity and Trust
5. Caring
6. Competence

Communication and the Nursing Process

Rapport Builders that Promotes Effective Communication:

1. Special Objectives
2. Comfortable Environment
3. Privacy
 4. Confidentiality
5. Patient Focus vs. Task Focus
6. Using Nursing Observation
7. Optimal Spacing
8. Respectful Personal Space

Guidelines when communicating with clients:

1. Conversational Skills:

• Control the tone of your voice

• Be knowledgeable about the topic of the conversation and have accurate
information
• Be flexible
• Be clear and concise, and make statements as simple as possible
• Avoid words that might have different interpretations
• Bev truthful
• Keep an open mind
• Take advantage of available opportunities

2. Listening Skills

• Do not cross your arms and legs

• Be alert and relaxed
• Keep conversation as natural as possible
• If culturally appropriate, maintain eye contact with the patient, without staring in
a face to face pose.
• Use appropriate facial expressions and body gestures
• Think before responding
• Do not pretend to listen
• Listen for theme’s in the patient’s comment

3. Interview Skills

• Talk clearly
• Educate the patient in professional manner
• Promote health teachings in simple way

Focus of therapeutic communication

• Reinforce self-worth
• Enhance self-concepts and confidence
• Learn coping strategies
• Examine relationship
• Achieve growth
• Solve problems
 • Extinguish of unwanted behavior

Therapeutic Nursing Process

The nurse promotes goal-directed activities that help to alleviate the discomfort of the client by promoting
growth and satisfy interpersonal relationship

Nursing Process

Definition: Deliberate way of thinking by nurses using an organized systematic framework (or structure)
of interrelated activities that is a scientific problem-solving approach towards individualized dynamic and
continuing interpersonal care for client’s changing responses and needs.

Components of the Nursing Process:

The common thread uniting different types of nurses who work in varied areas is the nursing
process—the essential core of practice for the registered nurse to deliver holistic, patient-focused
care.

Assessment
An RN uses a systematic, dynamic way to collect and analyze data about a client, the first step in
delivering nursing care. Assessment includes not only physiological data, but also psychological, socio-
cultural, spiritual, economic, and life-style factors as well. For example, a nurse’s assessment of a
hospitalized patient in pain includes not only the physical causes and manifestations of pain, but the
patient’s response—an inability to get out of bed, refusal to eat, and withdrawal from family members,
anger directed at hospital staff, fear, or request for more pain medication.

Diagnosis
The nursing diagnosis is the nurse’s clinical judgment about the client’s response to actual or potential
health conditions or needs. The diagnosis reflects not only that the patient is in pain, but that the pain has
caused other problems such as anxiety, poor nutrition, and conflict within the family, or has the potential
to cause complications—for example; respiratory infection is a potential hazard to an immobilized
patient. The diagnosis is the basis for the nurse’s care plan.

Planning
Based on the assessment and diagnosis, the nurse sets measurable and achievable short- and long-range
goals for this patient that might include moving from bed to chair at least three times per day; maintaining
adequate nutrition by eating smaller, more frequent meals; resolving conflict through counseling, or
managing pain through adequate medication. Assessment data, diagnosis, and goals are written in the
patient’s care plan so that nurses as well as other health professionals caring for the patient have access to
it.

Implementation
Nursing-care is implemented according to the care plan, so continuity of care for the patient during
hospitalization and in preparation for discharge needs to be assured. Care is documented in the patient’s
record.

Evaluation
Both the patient’s status and the effectiveness of the nursing care must be continuously evaluated, and the
care plan modified as needed.