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By: Phillip Ching
• Communication is the exchange of ideas between two or more
• It can be verbal, using words, or nonverbal, using actions such as
touch or eye contact or even a remote system such as mail or e-
• It is an important process in the care of children because it can
make or break an effective relationship.
Two Major Categories
Nontherapeutic Communication
• Nontherapeutic communication is identified by its lack of structure or planning—that is,
it lacks deliberate purpose other than socializing. Dinner conversation is an example of
nontherapeutic communication. (casual, everyday conversation)
Therapeutic Communication
• Therapeutic communication is an interaction between two people that is planned (you
deliberately intend to determine the true way a child feels), has structure (you use
specific wording techniques that will encourage the response you expect to elicit), and
is helpful and constructive (at the end of the exchange you will know more about the
child than you did at the beginning, and the child, ideally, also knows more about a
particular problem or concern). (helpful and constructive interchanges)
Components of a Good
• The encoder is the person who originates a message. Such a person desires to share a
thought or feeling with someone else.
• The code is the message that is conveyed, as well as the medium or system used to
convey it. Messages can also be conveyed by such methods as a painting, poem,
novel, Morse code, Braille, computer, television, CD, radio, audio or videotape, DVD,
camcorder, movie projector, telephone, or text messaging.
• The receiver (decoder) of the message is the person who not only receives it (hears it,
reads it, views it) but interprets or decodes its meaning (cognitive processing).
• Feedback is the reply the decoder returns to the sender to acknowledge the message
has been received and interpreted. This could be a spoken statement, a nod of the
head, a facial grimace, a return e-mail, or the sudden slamming of a telephone
Levels of Communications
First-Level: Cliché Conversation
• Cliché conversation is pleasant chatting or comments such as,
“Have a nice day” between people who do not intend their
relationship to extend beyond a superficial level. It is important
when meeting a child for the first time that you introduce yourself
not only with your name but also your position and function (“I’m
a student nurse who is going to take care of you”; “I’m a nurse
who will be visiting you in your home”). This information leads the
family to move the conversation from the cliché level to a more
meaningful one.
Levels of Communication
Second Level: Fact Reporting
Fact reporting is simply stating facts about oneself (“I’m 12; I’m in
sixth grade”). Fact reporting is necessary for you to understand
children, but it does not tell you anything about their feelings or
needs. Children can move from this level to a higher level of
communication only when they feel they can trust you with more
Levels of Communication
Third Level: Shared Personal Ideas and Judgments
• When children know you well, they are able to share ideas such
as, “I always wanted to be an astronaut” and judgments (“This is
too hard for me; I need to learn a different way”). This level of
communication exposes them to loss of self-esteem if their views
are not respected. It is the level that is the beginning of
therapeutic interactions.
Levels of Communication
Fourth Level: Shared Feelings
• It is difficult to share feelings until you truly trust one another,
because feelings are tenuous, fragile concepts, easily destroyed
and crushed by inept or uncaring comments. Listen carefully for
an expression of feeling from children such as, “I hate always
being sick.” These admissions are telling you much more than
how a child experiences the world; they represent trust in you
and the depth of the relationship the child has established with
Levels of Communication
Fifth Level: Peak Communication
• The fifth level of communication is a sense of oneness, or being
able to know what the other person is experiencing without it
actually being voiced.
Nonverbal Communication
• People generally consider the space directly surrounding them (up to 18 inches) as
intimate space, to be crossed only by people who know them well or with whom they
are comfortable having close body contact.
• The space between 18 inches to 4 feet is sensed by most people as personal space.
This is the distance people usually stand apart from each other for casual conversation.
• The distance between 4 feet and 12 feet is social space, the distance used to conduct
business or teach a class. Conversation spoken at this distance is readily heard by
• Distance beyond 12 feet is public space. To communicate from this distance, you need
to shout; privacy is not respected at all. Waving to a friend in a hallway or across a
parking lot is an example of public space communication.
Nonverbal Communication
• Genuineness is a quality of projecting sincerity or being yourself. Children will
have difficulty trusting you and therefore will be unable to move to a deep
relationship with you if you change your behavior from one day to the next
such as from maximum patience to short-tempered, because they have to
spend energy every day testing to see who you are that day.
• Warmth is an innate quality, and some people manifest it more spontaneously
than others. Basic ways in which warmth is demonstrated are direct eye
contact, use of a gentle tone of voice, listening attentively, approaching a
child within a comfortable space of 1 to 4 feet (closer may be threatening;
farther away may be distancing), and using touch appropriately.
Nonverbal Communication
• Empathy is the ability to put yourself in another person’s place and experience a
feeling the same as that person is experiencing. People who are capable of empathy
are the best supportpeople because they can anticipate a child’s reactions or fears.
• Gestures Children vary a great deal in the gestures they use to accompany their
spoken words. Although this is culturally influenced, it is also an individual trait. Be
careful not to assess emotion only by a child’s gestures; some children wave their arms
wildly describing an everyday occurrence; others would use that degree of expression
only when in extreme distress.
• Body Posture and Gait Children who feel good about themselves usually assume an
upright body posture and walk rapidly and surely; those who are depressed or insecure
tend to slouch and move more slowly and timidly; those who are threatened tend to
either draw back or act aggressively.
Nonverbal Communication
• General Appearance Children who have good self-esteem tend to maintain good
body hygiene and care about their appearance. Those who are depressed may not
feel the effort involved in grooming is worthwhile.
• Touch is the most intimate and meaningful of nonverbal techniques. When words are
inadequate, touch rarely is. Learn to use touch such as clapping a child’s shoulder or
squeezing a hand to accompany reassuring words or in place of words as a strong
support signal
• Other nonverbal communication are use of humor, use of music, and use of drawing
Techniques to encourage
therapeutic communication
Attentive Listening
• No one likes to talk to someone who does not appear to be listening or responding.
Good listening, therefore, like speaking, is not passive but active. Be aware that your
posture reveals to a great extent whether you are listening (sitting, not standing, to
convey that you are not on the run; leaning forward, not backward; stooping to meet
a child’s level). Nodding, maintaining eye contact, and stopping all other activities are
strong indicators you are attuned to what is being said.
Open-Ended Questions
• A pointed or direct question used in discussing asks for a specific task; it implies all you
are interested in hearing about is that one fact. An example of a direct question is, “Do
you take Tylenol when you have a headache?” An open-ended question is not limited
to a simple answer but invites a wide variety of responses because it is so
comprehensive such as, “Tell me what you do when you have a headache.”
Techniques to encourage
therapeutic communication
• Reflecting is restating the last word or phrase a child has said when there is a pause in
the communication.
• Clarifying consists of repeating statements others have made so both of you can be
certain you understood them.
• Paraphrasing is restating what children have said not only to assure them you have
heard correctly (as in clarifying) but also to help them explain what they have been
trying to say in other words.
Techniques to encourage
therapeutic communication
Perception Checking
• Perception checking documents a feeling or emotion reported to you. This makes it a
step deeper than paraphrasing. In paraphrasing, you document a statement or fact; in
perception checking, you document a feeling or emotion. Always ask for validation
that your perception is correct so you do not make false assumptions.
• Focusing helps children to center on a subject you suspect is causing them anxiety
because they comment about it indirectly or else completely avoid it. It is done by
repeating something they said (“You mentioned you feel tired all the time”) or by
mentioning the avoided topic (“You haven’t said a word about how you feel about
this surgery. Is that a problem?”).
Techniques to encourage
therapeutic communication
Supportive Statements
• Supportive statements let children know you accept their behavior or at least
appreciate they have dealt well with unfortunate circumstances. For example, an
adolescent says, “My girlfriend dumped me while I’ve been here in the hospital.” Such
a statement deserves a supportive reply such as, “That must not feel good.” The
adolescent will take this response to mean you want to discuss the topic and,
encouraged by your empathy, may elaborate on it as it still affects him.
Process Recording
• Process recording is a method to examine how effective you are at therapeutic
communication. After your next interaction with a child, take a few minutes and write
down in the left column of a sheet of paper a statement the child made to you.
Factors That Can Interfere With Effective
• Age and Developmental Level
• Intellectual Level
• Physical Factors
• Technical Terminology
• Showing Disapproval
• Not Showing Approval When Warranted
• Being Defensive
• Cliché Advice
• Cliché advice (advice given from a formula, not individualized to the situation) is
meaningless because it is too general to be helpful.
Types of Learning
• Cognitive learning involves a change in the individual’s level of
understanding or knowledge.
• Psychomotor learning requires a change in a person’s ability to
perform a skill.
• Affective learning involves a change in a person’s attitude and is
the most difficult area in which to bring about change. Affective
learning is gained best though role modeling, role playing, or
shared-experience discussion.