Fundamentals - Principles, part 7: Nursing Communication
The communication process, communication levels, forms of nonverbal communication, and therapeutic vs. non-therapeutic communication are important topics in Fundamentals of Nursing. Better communication leads to better care and better health outcomes. This article covers the key facts on nursing communication, including topics you are likely to be tested on and use every day in your nursing practice!
The Fundamentals of Nursing video series follows along with our Fundamentals of Nursing flashcards, which are intended to help RN and PN nursing students study for nursing school exams, including the ATI, HESI, and NCLEX.
The communication process is made up of the sender, the receiver, the message, the channel, and feedback.
Within the communication process, the sender is the person sending the message.
Within the communication process, the receiver is the person receiving the message.
Within the communication process, the message itself is the information that is being sent.
The channel is the format in which the message is being sent, like whether via speech (verbal), through email, a letter, or text message (written), or through video.
In the communication process, feedback is the receiver's response to the message.
Nursing communication can be intrapersonal, interpersonal, small group or public.
Intrapersonal communication is your internal thoughts and conversation happening inside your head. It's good practice to be aware of these.
In intrapersonal communication the sender and receiver are the same person.
IntrApersonal has an A for Alone.
Interpersonal communication is communication between two people. If you and a patient were having a direct conversation between the two of you, that is an example of interpersonal communication.
Though interpersonal and intrapersonal sound very similar, the Cool Chicken hint above can help you differentiate between the two.
Small group communication is when you are speaking to a small group of people, like in a small staff meeting.
Public communication is communicating with a large group of people in a public forum. A social media post could also be considered public communication.
Forms of nonverbal communication
Communication is not just the words you are saying, but how you communicate with your body language and physical presence. The different forms of nonverbal communication you'll need to know about are posture, expression, eye contact, gestures, touch, and silence.
For effective nonverbal communication, remember your ROLES: Relaxed body language, Open posture, Lean in, Eye contact, sit Squarely toward patient.
Posture is a very important part of nonverbal communication. If you are slumped over or have your arms crossed, you are communicating less openness and engagement in the situation or conversation.
The expression on your face is another key part of nonverbal communication. We can all visualize what a facial expression would look like for boredom, shock, triumph, sadness, and more—right? So, consider that others can easily read your facial expression as clues to your emotions.
Eye contact can be appropriate or inappropriate, depending on the circumstances and the receiver of the message. In some cultures, eye contact is not a respectful gesture, and it's important to practice good cultural competency. But if you are not in that situation, then intermittent eye contact is appropriate.
It's important to be aware that gestures that you are used to using, like a thumbs up, nodding for yes, shaking your head for no, and more, can have different meanings for other cultures. When in doubt, communicate verbally at the same time that gestures are used.
For example, in Greece, nodding your head up and down means no, whereas people in the US know this to mean yes! Verbal communication alongside gestures helps avoid misconstrued meaning.
Touch can be therapeutic in some circumstances. It may be a helpful thing to touch somebody's arm or hold their hand, but keep in mind this is not always appropriate nonverbal communication.
Therapeutic silence is a communication technique where silence is used to demonstrate empathy, listening, and offering of self, which we'll cover next. Sometimes the best thing you can do is just listen and be there quietly.
Therapeutic communication techniques
Therapeutic communication in nursing is communication that is helpful, effective, empathetic, and promotes the well-being of the patient. You will be heavily tested on therapeutic communication techniques throughout nursing school, because it is so important. How you communicate with your patients matters for how you are able to care for them and make them feel cared for.
Here, we've covered some therapeutic communication techniques to use, and some non-therapeutic communication techniques that you will want to avoid.
If you are interested in learning more about therapeutic communication techniques in the mental healthcare setting, check out our article Psychiatric Mental Health, Part 4: Nurse/client Relationship, Therapeutic Communication. The Psychiatric Mental Health series follows along with our Psychiatric Mental Health Nursing Flashcards.
Open-ended questions are questions that cannot be answered with a simple yes or no, and invite a broader range of responses. We want to encourage patients so share more with us.
The way that we ask a question can impact the type of response we receive. Most of us have ingrained patterns of communication where, if we are asked a yes or no question, we will respond yes or no. This likely is not enough information.
For example, "Tell me more about that," or "How are you feeling?" are good examples of open-ended questions. The patient will have more time to answer and won't be limited to a yes or no response.
Clarification or validation is when you seek understanding for something that the patient has said that is vague or confusing.
For example, you might ask the clarifying question, "Do I understand you correctly when you say this?"
Reflection is a technique to reflect a question back to the patient. For example, if a patient asks, "Do you think I should try that new medication?" then you might respond, "Well, what are your thoughts on that?"
It would not really be appropriate for you to give your opinion or advice, which we will cover later, as a direct answer to their question. You could say, "I can't answer that," which would immediately shut the conversation down, but a reflection is a more therapeutic technique because it keeps the conversation open and allows the patient to make their own decision.
Offering self is offering your physical presence and time; being with the patient and letting them know that you are there for them.
Restating is repeating what the patient said back to them, to confirm understanding. This actually works to help clarify for both the sender and the receiver
For example, a patient might say "I'm so anxious that I can't get to sleep," and your restating response might be, "Your anxiety is keeping you awake."
Non-therapeutic communication techniques
Non-therapeutic communication is communication that should be avoided because it is not empathetic, or does not prompt a helpful response. We learn about them so we can recognize them and know not to do them!
Just like we do want to ask open-ended questions, we do not want to ask close-ended questions. Close-ended questions are questions that prompt a yes or no response, or a single word response.
For example, "Are you in pain?" is a close-ended question, but the open-ended version of that is "Tell me about your pain."
We should never provide false reassurance. This means that we avoid saying things like, "Everything's going to be fine," or "I'm sure your surgery is going to go just fine." We should avoid this communication because we can't actually know the outcome, and giving false reassurance does not follow the principle of veracity.
Asking a patient a question beginning with Why is not therapeutic. For example, "Why are you so angry?" or "Why didn't you follow your treatment plan?" These types of questions give the patient the impression that we are judging them, and can understandably put them on the defensive.
Another communication to avoid is passing judgement, which is approving or disapproving of a patient. Approving may seem positive, but it is a judgement and therefore not appropriate. If you were to say, "Yes, you did the right thing," that would not be therapeutic.
Giving advice is something that nurses should avoid. If it starts with "you should" or "you shouldn't," it's not therapeutic.
Leading or biased questions
Leading or biased questions are questions phrased in such a way that you are communicating that you expect a specific answer. This is not therapeutic because patients may not feel safe or accepted to give the true answer. For example, "You don't smoke, do you?"
Changing the subject
The last non-therapeutic communication technique we'll share here is changing the subject. For example, if your patient brings something up and you said, "Let's talk about something else," that would be changing the subject. It's not therapeutic because it blocks communication and dissuades the patient from sharing again in the future.
Hi! I'm Meris, and today we're going to be talking about communication. I'm going to be following along with the Fundamentals of Nursing flashcards available on leveluprn.com. If you are following along with me, I'm starting on card number 18. There is a lot of bold red text on these cards, so be sure to pay attention to that because we called out the really important details. And we do have some Cool Chicken hints to help you remember the most important content coming up.
So first up, we're going to be talking about the communication process and the levels of communication. So the communication process is made up of:
the sender, the person sending the message,
the receiver, the person receiving the message,
the message itself, which is the information being sent,
the channel, which is the format in which the message is being sent, such as verbal, through email, through video,
and then feedback, which is the receiver's response to the message.
We also have communication levels.
So we have intrapersonal, which is a person's own, internal thoughts that's happening inside their head. We have an awesome Cool Chicken hint here, which is intrapersonal has an A for alone. If you have a better way to remember it, let me know in the comments now.
We also have interpersonal. Interpersonal is for communication between two people.
Then we have small group, so that would be speaking to a small group, maybe like a small staff meeting or something along that line.
And then public communication obviously is going to be communicating with a large group of people in the public forum.
Up next, we are talking about forms of nonverbal communication. Remember that communication is not just the words that you're saying, but it has to do with your posture, your body language, and those sorts of things. So let's talk about some different forms of nonverbal communication.
Your posture, like I said. If you're slumped over, if you have your arms crossed, all of that changes the nonverbal communication.
The expression. Is your face looking angry or bored, or are you excited and engaged and happy?
Eye contact. Remember that eye contact is not always a respectful gesture, so you need to be culturally competent. But if it is, then eye contact intermittently is appropriate.
Gestures. So gestures change based on the culture of the person and where you are. So things like thumbs up or nodding yes, shaking your head for no may have different meanings for other cultures.
Touch. Touch may be therapeutic. It may be a good thing to touch somebody's arm or to hold their hand, but keep in mind this is not always appropriate nonverbal communication.
And then silence. Therapeutic silence is a thing. Sometimes the best thing you can do is just listen and be there quietly.
Now we do have a good way to remember this. We have our Cool Chicken hint here. It's for effective nonverbal communication. Remember your roles, R-O-L-E-S. Relaxed body language, open posture, lean in, eye contact, sit squarely towards the patient. ROLES. If you have a better way to remember it, please let me know in the comments right now.
Okay. Now, we're going to be talking about therapeutic communication techniques. This is huge. I am telling you that you are going to be so highly tested on this because how you communicate with your patients matters for how you are able to care for them and make them feel cared for. So we have some therapeutic communication techniques. And after that, we'll talk about nontherapeutic.
Therapeutic communication techniques, a big one, and you can see it's bold and red on this card because it's very important, is using open-ended questions. We want to encourage our patients to share more with us. So a closed-ended question like a simple yes or no question, that's not going to be very therapeutic.
But something like, "Tell me more about," or, "How are you feeling?" Things like that would be open-ended so that the patient has more time to answer and they're not limited to a yes or a no.
We also have offering self. Again, that's just being with the patient, just letting them know that you're there for them.
We also have restating. So that's going to be saying what the patient said, but in a different way to confirm understanding. So our example here - and we have examples of all of these on the card - the example here is if the patient says, "I'm so anxious, I can't get to sleep," the nurse might restate to makes sure she understands and says, "Your anxiety is keeping you awake." That's restating.
So those are some therapeutic communication techniques. There's more on the card, so be sure to be familiar with all of those.
Okay. Lastly, we're going to cover non-therapeutic communication techniques. So these are techniques that you should avoid. These are techniques that we do not want to use.
On the opposite spectrum from open-ended questions are closed-ended questions. Closed-ended questions like, "Are you in pain?" That's not encouraging my patient to share too much. "Are you in pain?" versus, "Tell me about your pain," that's open-ended. "Are you in pain?" That's not very open-ended.
False reassurance. We never provide false reassurance, which means we're never going to say things like, "Everything's going to be fine," or "Oh, I'm sure your surgery is going to go just fine." We don't do that because we don't know that, and we're not going to give false reassurance because that doesn't follow the ethical principle of veracity, telling the truth.
Another one, and this is bold and red on this card. You know it's important. It's asking why. We never ask why because this gives our patient the sense that we are judging them.
So if my patient is upset, I'm not going to say, "Why are you so upset?" That doesn't really sound very good and therapeutic, does it? "Why are you so angry?" "Why don't you want to get out of bed?" And none of those questions make my patient want to share with me because it makes them feel as though they are being judged. So we absolutely want to avoid those.
A few more on this card that I'm not going to go into great detail, we have passing judgment and giving advice, leading or biased questions, or changing the subject. All of these are non-therapeutic communication techniques. And you can read more about them on the flashcard.
Okay. So that's it for communication. I hope that review was helpful. If it was, please be sure to like this video. If you have better ways to remember the content than the mnemonics that we have you, please comment below right now. We want to hear them.
Be sure to subscribe to the channel because we have some great stuff coming up, and you don't want to miss it.
For instance, in the next video, I'm going to be talking about patient education and nursing documentation, which are very important for fundamentals of nursing. Thanks so much for watching, and happy studying!
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