UNIVERSITY OF RWANDA

CMHS
SoNM
General Nursing Department

MODULE: FUNDAMENTAL OF NURSING

UNIT III: THE THERAPEUTIC NATURE OF
NURSING
By NKURANYABAHIZI Michel, RN, BScN, MScN
Learning objectives
• After completing thisUnit, you will be able to
• Describe therapeutic Communication
• Describe Nursing, Healing, and Caring
• Describe and provide Client Education
• Describe and apply Family Health Promotion and Illness Prevention behaviors
• Integrate patient and family concepts into patient care
1. THERAPEUTIC COMMUNICATION
•Leaning objectives:
•After completing this chapter, you will be able to:
Describe the components of the communication process.
 Discuss the various aspects that nurses need to consider when using the different forms of communication.
Describe factors influencing the communication process.
Compare and contrast therapeutic communication techniques that facilitate communication and focus on
client concerns.
Recognize barriers to communication.
Describe the four phases of the helping relationship.
Discuss characteristics of an effectively functioning group.
Identify types of groups helpful in promoting health and comfort.
Discuss how nurses use communication skills in each phase of the nursing process.
State why effective communication is imperative among health professionals.
Describe the following disruptive behaviors and how they affect the health care environment and client
safety: incivility, lateral violence, and bullying.
Discuss the differences between nurse and physician communication and how to address these differences.
Differentiate the major characteristics of assertive and nonassertive communication.
INTRODUCTION
• Communication is a critical skill for nursing.
• It is the process by which humans meet their survival needs, build relationships, and
experience emotions.
• In nursing, communication is a dynamic process used to gather assessment data, to teach
and persuade, and to express caring and comfort.
• Communication is an integral part of the helping relationship.
• The term communication has various meanings, depending on the context in which it is used.
• To some, communication is the interchange of information between two or more
people; in other words, the exchange of ideas or thoughts.
• This kind of communication uses methods such as talking and listening or writing and reading.
• However,painting, dancing, and storytelling are also methods of communication.
• In addition, thoughts are expressed to others not only by spoken or written words but also by
gestures or body actions.
INTRODUCTION (…)
• Communication is any means of exchanging information or feelings between two or more
people.
• The intent of any communication is to obtain a response.
• Communication has two main purposes:
• To influence others and
• To gain information.
• Nurses who communicate effectively are better able to:
• collect assessment data,
• initiate interventions,
• evaluate outcomes of interventions,
• initiate change that promotes health,
• prevent the safety and legal problems associated with nursing practice.
• The communication process is built on a trusting relationship with a client and support people.
• Effective communication is essential for the establishment of a nurse–client relationship.
THE COMMUNICATION PROCESS
• Communication is the process of transmitting thoughts, feelings, facts, and other
information, includes verbal and nonverbal behavior.
• In nursing, communication is the vehicle for establishing a therapeutic
relationship with a client.
• The quality of the relationship between the nurse and the client is directly
associated with the quality of communication between them.
COMPONENTS OF THE COMMUNICATION PROCESS

• The five major components of

the communication process are:
• Sender,
• Message,
• Channel,
• Receiver, and
• Feedback

Figure 1. A Communication Model

COMPONENTS OF THE COMMUNICATION PROCESS

1.The Sender
• The communication process begins when a person, known as the sender, generates a
message.
• Messages stem from a person’s need to relate to others, to create meanings, and to
understand various situations.
• Messages are generated by external factors, such as what the sender sees, hears, touches,
tastes, or smells.
• The sender also perceives internal stimuli that generate messages(Eg, hunger, fatigue)
• Encoding involves the use of language and other specific signs and symbols for sending
messages.
COMPONENTS OF THE COMMUNICATION PROCESS

2. The message
• The message is a stimulus produced by a sender and responded to by a receiver.
• Messages may be verbal, nonverbal, written materials, and arts.
3. The Channel
• The channel is the medium through which a message is transmitted.
• There are three major communication channels:
• Visual: sight, observation, and perception
• Auditory: spoken words and cues
• kinesthetic: experiencing sensations
COMPONENTS OF THE COMMUNICATION PROCESS

Your Dominant Channel

To determine which channel: visual, auditory, or kinesthetic is your dominant mode, ask yourself these questions. How do I
learn best: by seeing, hearing, or doing? When people speak, what do I pay most attention to: their appearance, their words,
or their actions?
COMPONENTS OF THE COMMUNICATION PROCESS

4. The Receiver
• The receiver is the person who intercepts the sender’s message.
• Receiving is influenced by:
• Physiological: the process of hearing
• Psychological: mental mechanisms that affect human behavior
• Cognitive processes: thinking. ( Through cognitive processing, the receiver decodes messages,
interprets them, and then provides feedback to the sender).
5. Feedback
• Feedback is the information the sender receives about the receiver’s reaction to the
message.
• The function of feedback is to provide the sender with information about the receiver’s
perception of a situation.
• The sender must transmit the message, and the receiver must provide feedback for a
communication to be complete.
CHARACTERISTICS OF EFFECTIVE FEEDBACK

• Specific rather than general

• Descriptive
• Provided in a supportive, nonthreatening manner
• Given in a timely manner (as soon as possible after the behavior or the message)
• Usable and appropriate to client needs
• Clear and unambiguous
• Direct and honest
FACTORS INFLUENCING COMMUNICATION
1. Perception
• Perception is a person’s sensing and understanding of the world.
• Perception of an event or situation is unique in that it varies from person to person.
• Perceptions are influenced by
• Our culture, socialization, education, and experience” (Ward-Collins, 1998, p. 29).
• Perceptions help a person determine the meaning of the words and the content of the
messages being communicated.
• Interpretation of the message depends upon the hearer’s perception of the message
FACTORS INFLUENCING COMMUNICATION
2. Cultural Context
• Because behavior is learned, nonverbal communication varies from culture to culture.
• For example, the messages communicated by touch and eye contact depend to a great
extent on one’s cultural context.

Discussion

Can you share other example of non verbal

communications which are culture
dependents?
FACTORS INFLUENCING COMMUNICATION
3. Space and Distance
• Each person has an invisible buffer zone or personal space.
• Culturally defined, this boundary alerts a person as to how close another can comfortably
approach.
• Invasion of personal space produces discomfort, anxiety, and the fight-or-flight response.
• The nurse respects the client’s personal space in several ways like:
• Not touching or
• Moving the client’s possessions unless necessary.
FACTORS INFLUENCING COMMUNICATION
4. Time
• The study of the effects of time on the communication process is referred to as
chronemics.
• The amount of time spent in communicating depends on the client’s needs.
• Some clients will require more of the nurse’s time than others.
• The client who is seriously ill or nontrusting may respond better to brief, frequent contact
than to prolonged, infrequent contact.
• If the nurse is hurried during the interaction with the client, a nonverbal message of
impatience may be transmitted.
• Keeping clients waiting conveys a message that they are unimportant.
• On the other hand, the nurse who is prompt and who allows time for the client to talk
communicates nonverbally, “You are important to me,” and “I value you as a person.”
• The whole communication process is influenced by time.
LEVELS OF COMMUNICATION
• Communication occurs at different levels, with each level influencing the others.
• There are three main communication levels:
• The intrapersonal,
• The interpersonal, and
• Group levels of communication.
LEVELS OF COMMUNICATION
1. Intrapersonal Level
• Intrapersonal communication is the messages
one sends to oneself, including self-talk, or
communication with oneself. A person receiving
internal or external messages organizes,
interprets, and assigns meaning to the
messages.
• The result of this process is the individual’s
unique way of perceiving.
• Self-talk can interfere with attention to others
and cause much to be missed during
interpersonal exchanges.
LEVELS OF COMMUNICATION
2. Interpersonal Level
• Interpersonal communication is the process that
occurs between two people either in face-to-face
encounters, over the telephone, or through other
communication media.
• Interpersonal communication builds on the
intrapersonal level in that each person
communicating must communicate with the self in
order to communicate with others.
• An important outcome of interpersonal
communication is the development of an
interpersonal relationship
• Interpersonal skills are essential competencies for
nurses. A Nurse Communicating with Client on the Interpersonal Level
LEVELS OF COMMUNICATION
3.Group Communication Level
• Group communication occurs when three or more people
meet in face-to-face encounters or through another
communication medium, such as a conference call.
• This level of communication is complex because of both
the number of people communicating intrapersonally
and interpersonally and the combinations of the people
involved.
• The study of the events that take place during group
interaction is called group dynamics. The dynamics of
any group can and will influence the productivity of the Group communication
group.
• Nurses deal with groups constantly as they interact with
families of clients, treatment teams, therapy groups, and
committees within their health care settings.
MODES OF COMMUNICATION
• Communication occurs in a variety of ways: through words, actions, or a combination of words and actions.
• When there is congruence (“a match”) between one’s words and actions, communication is enhanced.
• We have Two mains mode of communication
• Verbal communication Mode and
• Non Verbal Communication Mode
1. Verbal Messages 2. Nonverbal Messages
• Verbal messages are messages communicated through • Unspoken messages often carry more weight than
words and language, either spoken or written. verbal and paraverbal ones, and they can be more
• Verbalmessages are accompanied by paraverbal (also reliable.
referred to as paralinguistic) cues: tone and pitch of • Nonverbal messages are messages communicated
voice; speed, inflection, and volume; grunts without words: that is, through body language.
• Even when the words themselves are not understood, • Much of the communication between people is
the power of the paraverbal cues can lead to nonverbal.
understanding. • Nurses must pay attention to nonverbal
• For example, when a person speaking a foreign communication in order to determine the meaning of
language is angry, the paraverbal cues of yelling, changes in client behavior.
shouting, grunting, or hissing through clenched
teeth convey the message despite any language
barrier.
MODES OF COMMUNICATION
2. Nonverbal Messages
• Much of the communication between people is nonverbal.
• The following are the same of non verbal communications:
• Facial Expression
• Posture
• Gestures
• Touch
Physical Appearance and Artifacts
TYPES OF COMMUNICATION
• There are several types of communication:
• Social,
• Therapeutic,
• Formal: consists of written messages and the arts (may include lectures, reports, charting in
the client’s record, and public speaking).
TYPES OF COMMUNICATION
• Interdisciplinary Communication
• The health care team consists of the client and all medical personnel involved in providing
care. All members of the team perform important, though different, roles in the health care
delivery system
• It is important that all health care team members communicate with each other regarding
assessment, intervention outcomes, and client status.
• The interdependent nature of teams requires thoughtful and effective communication.
• Breakdown of communication between different team members can interfere with the
client’s treatment.
TYPES OF COMMUNICATION
• Therapeutic Communication
• Therapeutic communication is the use of communication for the purpose of creating a
beneficial outcome for the client.
• The accompanying display lists characteristics of therapeutic communication.
• Therapeutic communication, the purpose is to improve the client’s ability to function.
• Therapeutic communication facilitates the establishment of the nurse-client relationship
and fulfills the purposes of nursing
• Therapeutic communication forms a connection between client and nurse.
• According to Susman (1998), “Brain scans, biochemistry, and other technology cannot
replace dialogue; with its use, nurses have a unique, demanding, and irreplaceable role in
caring for patients.
TYPES OF COMMUNICATION
• Therapeutic Communication
• The essential elements of therapeutic communication are:
• Empathy,
• Trust,
• Honesty,
• Validation,
• Caring,
• A nonjudgmental approach,and
• Use of active listening.
THERAPEUTIC COMMUNICATION
THERAPEUTIC COMMUNICATION
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