The Nurse The Nurse as as

Communicator and Communicator and CounselorCounselor

Part One:Part One:

Therapeutic CommunicationTherapeutic Communication

Objectives: Objectives: Following completion of this program the Behavioral Following completion of this program the Behavioral

Health Nurse will be able to:Health Nurse will be able to:

• Describe the process of human communication.Describe the process of human communication.

• Define and Describe communication, non-verbal Define and Describe communication, non-verbal communication, therapeutic communication, communication, therapeutic communication, therapeutic relationships, listening skills and core therapeutic relationships, listening skills and core dimensions of counseling techniques.dimensions of counseling techniques.

Therapeutic Communication is…Therapeutic Communication is…

• A process that involves at least two people.A process that involves at least two people.

• The exchange of thoughts, messages, or The exchange of thoughts, messages, or information as by speech, signals, writing, or information as by speech, signals, writing, or behavior. behavior.

• The art and technique of using words The art and technique of using words effectively to impart information or ideas.effectively to impart information or ideas.

• Sender has responsibility for claritySender has responsibility for clarity

• Reputation plays a roleReputation plays a role

• Success may depend on the therapeutic Success may depend on the therapeutic relationshiprelationship

• Awareness of personal values and biases is Awareness of personal values and biases is essentialessential

• Feedback plays an important roleFeedback plays an important role

Therapeutic CommunicationTherapeutic CommunicationBasic PrinciplesBasic Principles

Therapeutic CommunicationTherapeutic Communication

• Verbal -Verbal - through words. through words.

• Non-verbal - Non-verbal - does not use spoken language. does not use spoken language. Sometimes may be the behaviors that Sometimes may be the behaviors that accompany words.accompany words.

• Para-verbalPara-verbal- information communicated by the - information communicated by the way words are spoken, the rate, tone, volume, way words are spoken, the rate, tone, volume, emphasis, inflection.emphasis, inflection.

Non-Verbal CommunicationNon-Verbal Communication

• May be obvious to you but hidden to the patient.May be obvious to you but hidden to the patient.

• May be obvious to the patient and hidden to you.May be obvious to the patient and hidden to you.

• Patients respond to your non-verbal behavior with Patients respond to your non-verbal behavior with or without their awareness.or without their awareness.

• Is important and may not be intentional.Is important and may not be intentional.

• Differ across cultures – Differ across cultures – eye contact, physical distance, eye contact, physical distance, touchtouch

• Be aware of your own and the patient’s.Be aware of your own and the patient’s.

Non-Verbal CommunicationNon-Verbal Communication

• Is interrelated with verbal behavior.Is interrelated with verbal behavior.

Examples of how verbal and non-verbal messages are related:Examples of how verbal and non-verbal messages are related:

Congruence – Congruence – when the verbal message and the non-verbal message when the verbal message and the non-verbal message

agree ex. “Come in” and a person smiles and gestures to a agree ex. “Come in” and a person smiles and gestures to a chair. Congruence demonstrates how the body shows chair. Congruence demonstrates how the body shows intensity ex. A person talks about being scared and talks intensity ex. A person talks about being scared and talks faster.faster.

Non-Congruence – Non-Congruence – when the non-verbal message and the verbal message when the non-verbal message and the verbal message

disagree ex. Person states, “I like you” with a frown face and disagree ex. Person states, “I like you” with a frown face and an angry voice. The non-verbal message often carries more an angry voice. The non-verbal message often carries more “weight”.“weight”.

Non-Verbal CommunicationNon-Verbal Communication

• Facial expressions communicate emotions. Primary Facial expressions communicate emotions. Primary emotions are hard-wired, automatic and universal. emotions are hard-wired, automatic and universal. The whole body conveys the intensity of the The whole body conveys the intensity of the emotion.emotion.

• Personal space is patient specific, adjust and be Personal space is patient specific, adjust and be aware, some patients may need 3 to 4 feet between aware, some patients may need 3 to 4 feet between them and the professionalthem and the professional..

• Sends information to the listener ex. When one nods Sends information to the listener ex. When one nods their head, a person keeps talking and if one shifts their head, a person keeps talking and if one shifts their body position, a person pauses when talking.their body position, a person pauses when talking.

Non-Verbal CommunicationNon-Verbal Communication

• It is often helpful to match or pace your behaviors It is often helpful to match or pace your behaviors with the patients.with the patients.

• Unless the patient is very agitated, use the same Unless the patient is very agitated, use the same intensity of voice, body posture and breathing intensity of voice, body posture and breathing pattern as the patient.pattern as the patient.

Silence….Silence….

• A period of reflection, confusion, guarded A period of reflection, confusion, guarded behavior or a cultural difference.behavior or a cultural difference.

• Do not fill-in short periods with talk automatically.Do not fill-in short periods with talk automatically.

• Pause and ask yourself about the meaning. Check Pause and ask yourself about the meaning. Check your assumptions – ask – “You’re sitting very your assumptions – ask – “You’re sitting very quietly, What is going on with you? Or “We were quietly, What is going on with you? Or “We were talking about… and there was a period of silence, talking about… and there was a period of silence, what does that mean to you?”what does that mean to you?”

Listening is hard workListening is hard work

• We must concentrateWe must concentrate

• We must focus on the otherWe must focus on the other

• When truly listening – our pulse and B/P When truly listening – our pulse and B/P rise, we start sweating!rise, we start sweating!

SPEEDSPEED

SpeechSpeech – 150 words per minute – 150 words per minuteThoughtThought – 400-500 words per minute – 400-500 words per minute

What happens in the gap?What happens in the gap?• Jump to conclusionsJump to conclusions• DaydreamDaydream• Plan a replyPlan a reply• Mentally argue with the speakerMentally argue with the speaker

Levels of ListeningLevels of Listening

Superficial listenerSuperficial listener• Hears sounds and words – not meaning and Hears sounds and words – not meaning and

contentcontent

• May be in the “speed gap”May be in the “speed gap”

Non – ListenerNon – Listener• Doesn’t hear; may pretend listening while Doesn’t hear; may pretend listening while

mentally elsewhere; interrupts; last wordmentally elsewhere; interrupts; last word

Levels of ListeningLevels of Listening

Evaluative listenerEvaluative listener• Actively trying to hear, but not making an effort Actively trying to hear, but not making an effort

to understand intentto understand intent

Logical listenerLogical listener • Content over feelings/meaningContent over feelings/meaning

• Catch the verbal, but miss the visual and vocal Catch the verbal, but miss the visual and vocal

• Believes that they understandBelieves that they understand

Definitions of Listening ResponsesDefinitions of Listening Responses(Core Counseling Skills)(Core Counseling Skills)

• Clarification Clarification – a question such as – “Do you – a question such as – “Do you mean that” or “Are you saying that “ plus a mean that” or “Are you saying that “ plus a rephrasing of the client’s messagerephrasing of the client’s message

• Para-phrase Para-phrase – a response to content , a – a response to content , a rephrasing of the content of the client’s messagerephrasing of the content of the client’s message

• ReflectionReflection – a response to feelings, a rephrasing – a response to feelings, a rephrasing of the affective part of the client’s messageof the affective part of the client’s message

• Summarization Summarization – two or more paraphrases or – two or more paraphrases or reflections that condense the client’s messages reflections that condense the client’s messages or the sessionor the session

More Examples…More Examples…

• It seems like….It seems like….

• It appears as…It appears as…

• From my perspective..From my perspective..

• As I see it…As I see it…

• I see what you mean..I see what you mean..

• It looks like…It looks like…

• Sounds like…Sounds like…

CommunicationCommunication

• Speaker doesn’t always feel Speaker doesn’t always feel understood.understood.

Due to gap between listening and thinking Due to gap between listening and thinking most of us are either superficial or most of us are either superficial or evaluative listeners.evaluative listeners.

Essentials of CommunicationEssentials of CommunicationThings that get in the way:Things that get in the way:

• Distractions -Distractions - noise, activity, people, heat, cold, noise, activity, people, heat, cold, weatherweather

• InterruptionsInterruptions

• Can it wait? Do you need to do it now?Can it wait? Do you need to do it now?

• Will the message create stress?Will the message create stress?

• How will the listener perceive and value the How will the listener perceive and value the message?message?

• Are their cultural or language barriers?Are their cultural or language barriers?

• Are we stereotyping?Are we stereotyping? race, socio- economic, race, socio- economic, regional, geographic, faith or sexual preferenceregional, geographic, faith or sexual preference

• Use Clear concise wordsUse Clear concise words

• Use language that the listener understandsUse language that the listener understands

• Evaluate your and the other persons stress levelEvaluate your and the other persons stress level

• Focus on the present Focus on the present

• Choose the right environmentChoose the right environment

• Choose the right timeChoose the right time

• PerceptionsPerceptions

• CultureCulture

• Need to convey an atmosphere - thatNeed to convey an atmosphere - that

regardless of time constraints you are regardless of time constraints you are

able to spend timeable to spend time

Keys to CommunicationKeys to Communication

Barriers to Good Barriers to Good CommunicationCommunication

You are bad or you did something bad Expressing dissatisfaction thru a third

party Assuming rather than checking out Communication cutoff Put-down question Should, could, would Sarcasm Commanding Premature advice

The 3 V’s of communicationThe 3 V’s of communication

____ % Verbal % Verbal – the words we use– the words we use

______ % Vocal % Vocal – our tone and intensity– our tone and intensity

“ “The music we play with our voiceThe music we play with our voice

______ % Visual % Visual – Everything the listener can see– Everything the listener can see

___ 100% Total = the actual meaning received___ 100% Total = the actual meaning received

Messages - Messages - FacilitativeFacilitative or Openor Open • Create positive outcomes Create positive outcomes

– People communicating with each other feel People communicating with each other feel good about their interactiongood about their interaction

– Usually begin with what or howUsually begin with what or how– Draw out feeling and ideasDraw out feeling and ideas– Encourage specific information on needs, Encourage specific information on needs,

wants, problems wants, problems – Stimulate thinking Stimulate thinking

Obstructive or NegativeObstructive or Negative These messages are fraught with difficulty and These messages are fraught with difficulty and

make effective communication nearly impossiblemake effective communication nearly impossible – Personalized criticismPersonalized criticism

•Negative comments about abilitiesNegative comments about abilities•Causes loss of confidence/self-esteemCauses loss of confidence/self-esteem

– Judgmental Comments Judgmental Comments •Negative or critical remarks about the work Negative or critical remarks about the work •Offers no information on what needs improvingOffers no information on what needs improving