10/16/23, 7:46 AM NURS410 - CH 8 ,9, 10, 11 - Psych nursing
CHAPTER EIGHT
Communication Skills: Medium for All Nursing Practice
Communication → transmission of ideas between people
● Influenced by personal, environmental, and relationship factors
○ Difference in status and power (nurse vs patient, student vs professor), social
determinants of health
● 10% Verbal, 90% Nonverbal → we look for communication to be congruent, the
content should be the same as the process
○ Double-bind messages
● Verbal communication → all the words spoken, talking is our link to one another
and the primary instrument of instruction
○ Words → symbols for emotions and mental images
● Nonverbal communication → body behaviors, facial expressions, eye cast,
voice-related behaviors, observable autonomic physiological responses,
personal appearance, physical characteristics
Effective Communication
● Nurse aims to help the patient feel understood & comfortable, identify and explore
problems relating to others, discover healthy ways of meeting emotional needs, and
experience satisfying interpersonal relationships
● Silence → specific channel for transmission and receiving message, a
powerful listening response, no universal rule about how much is too much or
enough, needs to serve a function and not come across as frightening for the
individual
○ Allows time for meaningful reflection
● Active Listening → observing the patient’s nonverbal behaviors, listening and
understanding the verbal message, listening and understanding a person in
the social context, and listening for “false notes”
○ Objective truth is never simple, everything you hear is modified by the patient’s
filters and your own filters, feeling confused or uncertain is OK, listen to yourself
too, by giving the patient undivided attention, the nurse communications that the
patient is not alone
○ Helps strengthen the patient’s ability to use critical thinking to solve problems
● Clarifying Techniques → understanding depends on clear communication
○ Paraphrasing → reflection of content; restating in different/fewer words
the basic content of the patient’s message
○ Restating → active listening strategy; mirror the patient's overt and
covert message, echo feelings as well as content
■ Repeating back the same key words
○ Reflection → statement or question that conveys the nurse’s
observation when discussing sensitive issues
■ “You sound as if you have a rough childhood”
○ Sharing Observations → shows acceptance; helps make the patient
aware of feelings and encourages the patient to own them
○ Exploring → Encouraging the patient to open up further
■ “Tell me more about…”
○ Questions
■ Open-ended → good idea to use early on, can help establish rapport
when someone is more guarded or resistant; not intrusive, encourages
the patient to share information
■ Closed ended → when used sparingly can get you needed
information
■ Projective (“What if…”) → help imagine the conflicts, thoughts,
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,10/16/23, 7:46 AM NURS410 - CH 8 ,9, 10, 11 - Psych nursing
■ “Tell me more about…”
○ Questions
■ Open-ended → good idea to use early on, can help establish rapport
when someone is more guarded or resistant; not intrusive, encourages
the patient to share information
■ Closed ended → when used sparingly can get you needed
information
■ Projective (“What if…”) → help imagine the conflicts, thoughts,
values, and behaviors/feelings they might have in certain
situations, helps explore in a safe environment
● What if you could go back and change your relationship with your
mother?
● What if you could back and change how you acted? What would
you do differently?
■ Presupposition (“Miracle”) → helps to explore the patient’s goals
or motivation by asking a hypothetical question where their
mental disorder is gone
● Offering self → demonstrates willingness to spend time with the client,
indicates genuine concern
● Focusing → helps client to concentrate on what is important
● Presenting reality → help client focus on what is actually happening and to
dispel delusions, hallucinations, or faulty beliefs
● Summarizing → emphasizes important points and reviews what has been
discussed
● Touch → can communicate caring and provide comfort
● Offering general leads → encourages the client to determine where the
communication can start and continue talking
● Showing acceptance & recognition → acknowledges the nurse’s interest and
non judgemental attitude
● Giving information → provides details that the client might need for decision
making
● Additional techniques → broad openings, time/sequence, encouraging
comparison, evaluation & description of perception, translate into feelings,
voicing doubt, suggesting collaboration, seeking validation/clarification,
verbalizing the implied, formulating a plan of action
Non-Therapeutic Techniques → excessive questioning, giving approval/disapproval,
giving premature advice, asking “why” questions, changing the subject, making
value judgements, false reassurance, minimizing feelings, offering personal
opinions, asking irrelevant personal questions
Cultural considerations → clarify what is meant by certain words, be open to better
understanding others backgrounds and cultural perceptions, recognize varying
degrees of diversity among and within most cultural groups
● Communication style → some find it normal to use expressive body language
while others do not
○ Asians → calm facade that masks distress; negative emotions may be
considered a private matter
○ Germans → value the concept of self-control and may show little facial
emotion
○ Italians → often animated in terms of facial expressions and hand
gestures
● Eye contact → some may find it disrespectful (Japan)
○ Should not be used to assess attentiveness, judge truthfulness, or make
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○ Asians → calm facade that masks distress; negative emotions may be
considered a private matter
○ Germans → value the concept of self-control and may show little facial
emotion
○ Italians → often animated in terms of facial expressions and hand
gestures
● Eye contact → some may find it disrespectful (Japan)
○ Should not be used to assess attentiveness, judge truthfulness, or make
assumptions on the degree of engagement one has with a patient
● Touch → some facilities may have a “no-touch” policy for children
Affirmative Psychotherapy → validates and advocates for the needs of individuals,
therapist demonstrates affirming stance towards client; often used with the LGBTQ+
community
Telehealth → use of electronic information and telecommunication to support long-distance
clinical health care to eliminate barriers from the delivery of services (phone calls, text, video
chat, mobile apps)
● Especially beneficial to patients who are chronically ill, home-bound, live in rural
areas, or who are underserved
○ DOD is working on telehealth for active-duty military personnel & their
families
● May aid in nursing shortage
● Mobile app concerns → lack of current clinical data, safety of apps, liability
issues, privacy and confidentiality
Therapeutic communication → professional, goal-directed, scientifically-based
Berlo’s Classic Communication Model (1960)
● Communicating with others is needed = stimulus
Operational Definition of Communication
● Stimulus → need for information, comfort, advice
● Sender → message filters through personal factors (agenda/goals, bias,
relationships, culture, past experiences, mood/attitude, value system,
knowledge, ability to relate to others, environmental factors, gender roles)
● Message → verbal, nonverbal (visual, tactile, smell, silence)
○ Influenced by transmission quality → amount of input, clarity of input,
relevance of input
● Receiver → message evaluated through personal filters
● Formulation of Feedback → agrees/disagrees, needs clarification, provides or
request information
● Consider social, relational, and cultural context
Practice Questions
1. An adult experiencing a recent exacerbation of ulcerative colitis tells the nurse, “I
had an accident while I was at the grocery store. It was so embarrassing.” Select
the nurse’s therapeutic response.
a. “Most grocery stores have public restrooms available.”
b. “Tell me more about how you felt when that happened.”
c. “People usually have compassion about those types of events.”
d. “Your disease is in remission now, so that is not likely to happen again.”
2. A patient has been out of work for 3 weeks with a major illness and anticipates
another month of recovery. The patient tells the nurse, “I’m trying to keep up with
my work email from home. They hired a new person in my department, but that
person has no experience.” Select the nurse’s therapeutic response.
a. “It sounds like you’re saying you are worried about your job security.”
b “N t t k ith j b hil i ”
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