Online Companion: Fundamentals of Nursing Standards and Practice 2E

Frequently Asked Questions

Do the guidelines and techniques for therapeutic communication interfere with natural and spontaneous interaction between the nurse and client?

Natural and spontaneous communication is characteristic of the social type of communication. The nurse -client interaction uses therapeutic communication to achieve the goal of improving the client's ability to function. In therapeutic interaction, the nurse has a purpose and goals for the interaction. The nurse focuses on the client during the interaction and uses specific, well-planned communication techniques to achieve the goals. Beginning nurses often feel uncomfortable when learning to use these communication techniques because this is a new type of communication. Like other skills in nursing, practice and experience lead to increased comfort level with using therapeutic communication.

How can therapeutic communication occur when the client is unconscious or aphasic?

The nurse is aware that communication happens in every situation; it cannot "not happen". The task for the nurse is to make the communication at a therapeutic level; that it, communication that will improve the client's ability to function. In clinical situations such as an unconscious or aphasic client, the nurse uses nonverbal communication to send messages to the client. The unconscious client may respond to touch, to gentleness when body parts are moved or the body is turned from side to side. The aphasic client can see the nurse's facial expression and may respond to gestures or be able to understand messages in pictures or words. The nurse uses understanding of the five components of the communication process to assess the client's ability to send and receive messages. The aphasic client may be able to write down messages. The client may be able to nod for "Yes" and "No" questions. The client may be able to learn a basic communication system by designating one, two or three fingers or use a hand squeeze as responses. There are electronic communication boards to enhance communication. The nurse assesses the aphasic client's ability to understand messages, that is, to be a receiver of communication. Are the client's responses appropriate to the nurses's verbal message or to a situation? This is the feedback component of communication. For the unconscious client, the nurse assesses for subtle physical responses as signs of awareness of stimuli. The nurse assumes the unconscious client can hear and gives verbal messages to the client when providing care. The nurse encourages family members to talk to the client during visits. The need to communicate is a basic human need. The nurse works to find a way to communicate with the client and to overcome barriers to communication.

The list of communication roadblocks includes responses that are commonly used. What will happen if I make these comments to a client?

The communication roadblocks are comments and responses that are socially acceptable and used frequently in social interactions. They are not useful in therapeutic interactions. The nurse's first step is to be aware of the ways these roadblocks interfere with helping the client. Then the nurse can use the more effective strategies suggested by the therapeutic techniques. It should be remembered that the communication techniques are tools for building relationships with clients. The tools are not as important as the honest, caring attitude that the nurse brings to the nurse-client interactions.