patient communication assignment quizlet

Strategies for effective patient communication

Communication is an exchange of information between two persons—a sender and a receiver. But it doesn’t end there. Feedback is an essential component because it closes the loop of the communication process: It validates how effective communication is and confirms exactly what is interpreted during the exchange of information.

Effective communication can be challenging, but some simple strategies can boost your chances of success.

Value of communication

Communicating with patients is often complex; each patient usually has multiple healthcare providers involved in his or her care. Effective communication is necessary to provide a positive benefit for patients. Communication with patients can help build a rapport, involve patients in decisions, reduce their anxiety, and increase their adherence, cooperation, and satisfaction. Ineffective communication contributes to poor outcomes, decreased quality of care, medical errors, and psychological stress for patients. It can cause them to feel unsafe and uninformed and to perceive staff as being inexperienced, incompetent, or unknowledgeable.

Effective communication is an important component of quality patient care. In acute care, there are specific communication questions used in reporting quality indicators. For example, there are questions about communication with nurses, communication about medications, communication about pain, and communication between the healthcare team. These quality indicator scores can affect payment for healthcare organizations.

Being a more effective communicator

Effective communication has to be an intentional process. Interpersonal skills should include listening, showing empathy, being patient, mindful of body language and tone of voice, thinking before speaking, not interrupting, and being open to receiving patient feedback.

Barriers should be identified and considered in order to provide the best environment and opportunity to exchange information. Barriers to consider include medical jargon, noise and other distractions, hearing or speech deficits, language, culture, time, and family dynamics.

Using interpersonal skills and addressing barriers aligns with the concepts of patient-centered care. Specific questions to consider in the clinical setting are:

What concerns do you have about your plan of care?
What questions do you have about your medications?
Did I answer your question(s) clearly?

Listen closely for feedback from patients. Feedback provides an opportunity to improve patient understanding, improve the patient care experience, and provide better care.

Other suggestions include:

Round with the physician team and read consult and progress notes daily. Doing this ensures that you have the most up to date and accurate information in order to answer the patient’s question(s).
Review information periodically with the patient to improve understanding.
Use the patient communication boards in the room to set goals and communicate with patient/family and other healthcare providers. This could reduce call light use about questions related to diet and activity orders. It could also give patients and families the feeling that they know what is going on.
Use electronic resources for printed information on medical procedures, conditions, and medications. It helps to have multiple ways to provide information.

Finally, reflect on your institution’s mission, vision, and values periodically. It will serve as a goal and reminder for you in your daily practice.

LaQuana L. Smith is an RN V staff nurse/clinical expert at the University of Arkansas for Medical Sciences in Little Rock.

Selected references

Ayuob NN, Qadi MA, El Deek BS, Boker AM. Evaluation of a communication skills training course for medical students using peer role-play. J Pak Med Assoc. 2017;67(5):745-51.

Hashim MJ. Patient-centered communication: Basic skills. Am Fam Physician. 2017;95(1):29-34.

Kanward L, Whiffin C, Spalek B. Feeling unsafe in the healthcare setting: patients’ perspectives. Br J Nurs . 2017;26(3):143-49.

Norouzinia R, Aghabarari M, Shiri M, Karimi M, Samami E. (2016). Communication barriers perceived by nurses and patients. Global Journal of Health Science. 2016;8(16):65-74.

The views and opinions expressed by Perspectives contributors are those of the author and do not necessarily reflect the opinions or recommendations of the American Nurses Association, the Editorial Advisory Board members, or the Publisher, Editors and staff of American Nurse Journal . These are opinion pieces and are not peer reviewed.

2 Comments .

I loved this article! I think communication plays a pretty big role in everything we do with a patient!

Thank you for this helpful i information on communication. I am a recent nurse graduate who will be starting my nursing career in Burlington, MA. I’m always seeking ways to improve and be a better communicator in everything I say. Spanish being my first language, I sometimes feel that I become nervous when communicating important stuff to patients and their families. So this information will help me be better prepared to provide the best care to my patients and further improve with the suggestions and strategies provided. Thank you!

Comments are closed.

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Patient-Clinician Communication: Basic Principles and Expectations

Marketing experts, decision scientists, patient advocates, and clinicians have developed a set of guiding principles and basic expectations underpinning patient-clinician communication. The work was stewarded under the auspices of the Best Practices and Evidence Communication Innovation Collaboratives of the Institute of Medicine (IOM) Roundtable on Value & Science-Driven Health Care. Collaborative participants intend these principles and expectations to serve as common touchstone reference points for both patients and clinicians, as they and their related organizations seek to foster the partnership and patient engagement necessary to improve health outcomes and value from care delivered.

Health care aims to maintain and improve patients’ conditions with respect to disease, injury, functional status, and sense of well-being. Accomplishment of these aims is predicated upon a strong patient-clinician partnership, in which the insights of both parties are drawn upon to guide delivery of the best care, tailored to individual circumstances. An important component of this partnership is effective patient-clinician communication.

In the 2001 IOM report Crossing the Quality Chasm, patient-centeredness was defined as one of the six key characteristics of quality care and has continued to be emphasized throughout the IOM’s Learning Health System series of publications. Dimensions of patient-centeredness include respect for patient values, preferences, and expressed needs along with a focus on information, communication, and education of patients in clear terms. Consistent and effective communication between patient and clinician has been associated in studies not only with improved patient satisfaction and safety, but also ultimately with better health outcomes, and often with lower costs. Breakdowns of communication, or disregard for patient understanding, context, and preferences, have been cited as contributors to health care disparities and other counterproductive variations in health care utilization rates. Moreover, professional ethics in health care stress the intrinsic importance of respectful and effective communication as a core aspect of informed consent and a trusting relationship.

In an era of increasingly personalized medicine and escalating clinical complexity, the importance of effective communication between the patient and the clinician is greater than ever. As the ultimate stakeholders, patients should expect an active role in, and often shared responsibility for, making care decisions that are best for them. Clinicians, in turn, should respect and support patients in this role, valuing their input and prioritizing their preferences in shaping care choices.

Whether considering risks and benefits or personal values and preferences, patients and clinicians each have unique and important information to contribute to understanding and deciding on prevention, diagnosis, or treatment options. Obtaining the highest-value care for each individual requires establishing common goals and expectations for care through shared deliberation that marshals the best information. Effective communication therefore requires clarity about patient and clinician roles, responsibilities, and expectations for health care; principles to guide the spirit and nature of patient-clinician communication; and approaches to tailor communication appropriately to circumstances (e.g., routine care, chronic disease management, life-threatening disease) and individual patient needs (e.g., health literacy and numeracy, living circumstances, language barriers, decision-making capacity).

Passage of the Patient Protection and Affordable Care Act of 2010 offers both opportunity and mandate to reorient strategies, incentives, and practices in support of health care that reliably delivers Americans the best care at the highest value—care that is effective, efficient, and most appropriate for the circumstances. As an element of best practice, the effectiveness of patient-clinician communication can be as important as that of a diagnostic or treatment tool and should be the product of similarly systematic assessment and evaluation. The principles and expectations identified in this document offer a framework to evaluate and improve patient-clinician communication, and to sharpen and focus patient discussion tools, patient safety assessment (e.g., the Agency for Healthcare Research and Quality [AHRQ], the National Quality Forum [NQF], organizational and individual performance assessment and quality improvement efforts (e.g., Consumer Assessment of Healthcare Providers and Systems [CAHPS], and clinician certification processes (e.g., the American Board of Internal Medicine [ABIM]).

Basic Principles and Expectations for Patient-Clinician Communication

Many factors affect the quality and clarity of communications between patients and clinicians. However, at the core of the matter, certain basic principles pertain and serve as the starting point for the expectations of patients and clinicians: mutual respect, harmonized goals, a supportive environment, appropriate decision partners, the right information, full disclosure, and continuous learning.

Patient-Clinician Communication, Basic Principles

Mutual respect
Harmonized goals
A supportive environment
Appropriate decision partners
The right information
Transparency and full disclosure
Continuous learning

Drawing from these principles, the basic individual and mutual expectations of both patients and their clinicians can be identified. These expectations are discussed below and summarized in the accompanying box.

1. Mutual respect

Each patient (or agent) and clinician engaged as full decision-making partners. Communication should seek to enhance health care decision making through the exchange of information and by supporting the development of a partnership relationship—whenever possible—based on trust and focused on the whole patient. This includes considering psychosocial needs, identifying and playing to the patient’s strengths, and building on past experience to meet immediate needs and anticipate future concerns.
Respect for the special insights that each brings to solving the problem at hand. Information exchange should be characterized by listening, inquiry, and facilitation that is both active and respectful on the part of both the patient and the clinician. Information needs include patients’ ideas, preferences, and values; living and economic contexts that may affect patients’ health or decision making; the basis and evidence for alternative choices and recommendations; and uncertainties related to the proposed course of action.

2. Harmonized goals

Common understanding of and agreement on the care plan. Full understanding—to the extent practicable—of care options and the associated risks, benefits, and costs, as well as patient preferences and expectations, should lead to an explicit determination of the shared agenda and goals. Factors should include health, lifestyle, and economic preferences and should accommodate language or cultural differences and low health literacy.

3. A supportive environment

A nurturing and secure services environment. The success of the care plan depends on the attention paid in the service setting to patient culture, skills, convenience, information, costs, and implementation of the care decision.
A nurturing and secure decision climate. The comfort and ability of the patient and clinician to speak openly is paramount to discussion of potentially sensitive issues inherent to many health decisions.

4. Appropriate decision partners

Clinicians, or clinician teams, with skills appropriate to patient circumstances. With increasingly complex problems, and time often a factor for any individual clinician, it is important to ensure that the patient has access to clinicians with skills appropriate to a particular encounter; that, as indicated, alternative clinician opinions are embraced; and that provisions are made for the communication needed among all relevant clinicians.
Assurance of competence and understanding by patient or agent of the patient. Understanding by both patient and clinician is crucial to arriving at the most appropriate decision. Understanding of patient options is important: how specific they are to circumstances; the associated risks, benefits, and costs; and the needed follow-up. If indicated, an appropriate family member or similar designee should be identified to act as the patient’s agent in the care process.

5. The right information

Best available information at hand, choices and trade-offs thoroughly discussed. The starting point for shared decision making should be the sharing of all necessary information. When working collaboratively to craft an appropriate care plan, clinicians should provide evidence concerning risks, benefits, values, and costs of alternative options. All options should be discussed to bring outpatient preferences, goals, and concerns and to explicitly consider the impact of various options on these issues.
Presentation by patient of relevant perceptions, symptoms, personal practices. The clinician’s appreciation and understanding of patient circumstances depends on accurate sharing by the patient of perceptions, symptoms, life events, and personal practices that may have a bearing on the condition and its management.

6. Transparency and full disclosure

Candid and explicit acknowledgment to patient of limits in science and system. A basic element of the care process is comprehensiveness and candor with respect to the limits of the evidence, delivery system constraints, and costs to the patient that may affect the range of options or the effectiveness of their delivery.
Patient openness to clinician on all relevant circumstances, preferences, medical history. Only by understanding the patient’s situation can the most appropriate care be identified. Patient and family or agent openness in sharing all relevant health and economic circumstances, preferences, and medical history ensures that decisions are made with complete understanding of the situation at hand.

7. Continuous learning

Effective approach established for regular feedback on progress. Identification and implementation of a system of feedback between patients and clinicians on status, progress, and challenges is integral to the development of a learning relationship that is flexible and can adapt to changing needs and situations.
Established periodicity for course assessment and alteration as necessary. Early specification of treatment strategy, expectations, and course correction points is important for ongoing assessment of care efficacy and to alert both clinician and patient to possible need for care strategy changes.

Expectations

Each patient (or agent) and clinician engaged as full decision-making partners.
Respect for the special insights that each brings to solving the problem at hand.
Common understanding of and agreement on the care plan.
A nurturing and secure services environment.
A nurturing and secure decision climate.
Clinicians, or clinician teams, with skills appropriate to patient circumstances.
Assurances of competence and understanding by patient or agent of the patient.
Best available evidence at hand, choices and trade-offs thoroughly discussed.
Presentation by patient of relevant perceptions, symptoms, personal practices.
Candid and explicit acknowledgment to patient of limits in science and system.
Patient openness to clinician on all relevant circumstances, preferences, medical history.
Effective approach established for regular feedback on progress.
Established periodicity for course assessment and alteration as necessary.

Tailoring Implementation to Need and Circumstance

These principles and expectations offer general guidance for successful patient-clinician communication. Moderating factors or constraints present in individual circumstances require certain tailored approaches and expectations for a particular visit—still with the aim of maximizing faithfulness to these principles to the fullest practical extent. Examples of such considerations include:

Visit Reason

Chronic condition management
Acute or urgent episode

Decision characteristics

Number of decisions to be made during the visit
Certainty, uncertainty, and relevance to the available evidence
Decisions related to a preference-sensitive arena or choice
Access to and use of the Internet

Patient characteristics

Functional capacity (level of physical or mental impairment)
Communication capacity (language, literacy/numeracy, speech disorder)
Receptivity (motivation, incentives, activation, learning style, trust level)
Support (skilled family or other caregiver, financial capacity)
Living situation (housing, community, grocery, pharmacy, recreation, safety)

Clinician and practice characteristics

Patient volume and complexity
Patient support systems (language aids, interpreters, physical space, digital capacity)
Decision support systems (digital platform, information access, decision guidance)
Professional team profile and culture
Condition-specific skill network and referral follow-up systems
Reimbursement and other economic barriers

Developing the Tools and Processes for Adaptive Targeting

As touchstone reference points for patients and clinicians, the principles and expectations presented here are vital to achieving the full measure of potential health outcomes and value from care delivered. But achieving that potential requires intent, commitment, and creativity in developing the tools and processes for adaptive targeting in the myriad conditions and circumstances found in different health care settings. Noted below are questions that may stimulate thought, conversation, and innovative approaches to their successful implementation in various settings and circumstances.

For clinicians and health care organizations

How are we doing now with respect to the principles and expectations?
For which of them is our current culture and practice pattern most challenging?
What initial steps might be good starting points for systems changes necessary?
How can we enlist patients and staff working together to help develop and lead?
How can we take advantage of initiative and help from professional societies?
What community tools or resources might be adaptable for us?
How can we measure the impact for feedback to patients and staff on the results?

For patients, consumers, and advocates

What makes a clinician a good listener?
What should we expect in conversations about health care with clinicians?
How can available care and condition-specific materials be more easily understandable?
Are there helpful ways to judge a care setting’s support of effective communication?
What should we expect from clinicians to help interpret medical evidence?
How can we best help clinicians in their efforts to improve information sharing?
How will “continuous learning” from my care lead to better health care?

For professional societies, policy makers, health plans, insurers, and employers

How do current practices compare with the principles and expectations?
What ought to be our expectations for clinicians we support?
What metrics will be most useful for quality improvement and feedback?
What tools are most needed to assist in application- and site-specific tailoring?
Can we develop case material to illustrate approaches and feasibility?
What information can help demonstrate material returns in outcomes and value?
Which reimbursement incentives structures are most important to consider?
Godolphin, W. 2009. Shared decision-making. Healthcare Quarterly. 12:e186-190. IOM (Institute of Medicine). 2001. Crossing the Quality Chasm: A New Health System for the 21st Century. Washington, DC: The National Academies Press.
______ . 2003. Unequal Treatment: Confronting Racial and Ethnic Disparities in Health Care. Washington, DC: The National Academies Press.
Stewart, M., J. B. Brown, H. Boon, J. Galajda, L. Meredith, and M. Sangster. 1999. Evidence on patient-doctor communication. Cancer Prevention and Control. 3(1):25-30.
Stewart, M. A. 1995. Effective physician-patient communication and health outcomes: A review. CMAJ 152(9)1423-1433.
Wennberg, J. E., A. M. O’Connor, E. D. Collins, and J. N. Weinstein. 2007. Extending the P4P agenda, part 1: How Medicare can improve patient decision making and reduce unnecessary care. Health Affairs 26(6):1564-1574.

Image credit: Joan M. Mas. Some rights reserved.

https://doi.org/10.31478/201106a

Suggested Citation

Paget, L., P. Han, S. Nedza, P. Kurtz, E. Racine, S. Russell, J. Santa, M. J. Schumann, J. Simha, and I. Von Kohorn. 2011. Patient-Clinician Communication: Basic Principles and Expectations. NAM Perspectives. Discussion Paper, National Academy of Medicine, Washington, DC. https://doi.org/10.31478/201106a

The views expressed in this paper are those of the authors and not necessarily of the authors’ organizations, the National Academy of Medicine (NAM), or the National Academies of Sciences, Engineering, and Medicine (the National Academies). The paper is intended to help inform and stimulate discussion. It is not a report of the NAM or the National Academies. Copyright by the National Academy of Sciences. All rights reserved.

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These five strategies can help you create positive and compassionate patient interactions without adding significant time to the visit.

SHANNON J. VOOGT, MD, KELLI PRATT, DO, AND AMBER ROLLET, MD

Fam Pract Manag. 2022;29(2):12-16

Author disclosures: no relevant financial relationships.

It has been a busy day in clinic, and your 10th patient of the morning is roomed 30 minutes late. The reason given for the visit is “preventive health.” When you enter the exam room, you introduce yourself and confirm the patient is there for a preventive check-up. Then you ask about health behaviors and screenings, do an exam, and make a plan for testing and immunizations. As you are finishing up the visit, the patient says, “But we never discussed my concerns. I'm having this wrist pain and hand numbness, which have been bothering me a lot. And I keep getting headaches. I'm having one right now, and it's terrible. And my knees are giving out on me a lot, and I'm wondering what you think I should do.” Feeling exasperated, you explain that you don't have time to address these complaints and the patient should follow up at a later date because you have other patients waiting. The patient agrees and leaves, but later gives you a poor review and switches to another practice because “My concerns weren't listened to.”

WHY COMMUNICATION MATTERS

A positive patient experience is the result of multiple factors before, during, and after the patient encounter, but chief among them is effective doctor-patient communication. When patients and physicians communicate well, outcomes are better, 1 in part because patients are more engaged in their health care. Patients who take an active role in their health can confidently bring up concerns and make lifestyle changes. 2

Physicians are constantly being evaluated as communicators — through online ratings, post-visit surveys, etc. Although patient satisfaction scores can push us to improve, they may also add performance pressures if we lose sight of the true goal, which is not to improve “scores” but to build trust. 3

This article describes how we can improve communication with our patients without pushing ourselves toward more burnout. Because time constraints are the primary concern for most physicians, we have chosen to focus on five strategies that create positive and compassionate interactions without adding significantly to the time with the patient.

When patients and physicians communicate well, outcomes are better, and patients are engaged in their health care.

Making a non-medical “connection” with the patient at the beginning of the encounter takes 1–2 minutes but can improve the patient's perception of the interaction.

Agenda-setting, open-ended questions, reflective statements, and visit summaries are strategies that can improve communication without adding much time to the visit.

1. MAKE A POSITIVE CONNECTION WITH THE PATIENT

Making a positive connection is not always easy, especially when our days are rushed and we are stressed and distracted, but each encounter should set the stage for respectful communication.

Before entering the exam room, take a slow, mindful breath to re-center yourself. When entering the room, make eye contact with the patient, warmly introduce yourself, and explain your role. Clarify how the patient would like to be addressed and include others in the room in the introduction. Although it's tempting to start by asking “How are you?” this can be confusing for the patient, who is there seeking care for a concern, and it may jump-start the medical interview before introductions have finished. Making a non-medical “connection” with the patient at the beginning of the encounter takes only 1–2 minutes but can improve the patient's perception of the interaction. 4 This can be a simple comment about weather, sports, or other neutral topics. At the end of the encounter, thank the patient for entrusting their care to you.

Here are some examples of language physicians can use to make positive connections:

“Hi, I am Dr. Smith, one of the family physicians here. How would you like me to call you?”

“Well, it's nice to meet you, Rhonda. Who do you have with you today?”

“It's nice to meet you. Is it still snowing outside? It's been so cold today!”

“Thank you so much for coming to see me today. I really appreciate that you trusted us with this problem.”

2. DEMONSTRATE ACTIVE LISTENING

One common patient complaint is that physicians do not listen carefully to what they have to say. We can demonstrate active listening in several ways:

Attend to patients without multitasking or distractions,

Express nonverbally that we are listening through eye contact, sitting down, nodding, responding with facial expressions, and showing concern,

Provide verbal cues (“Mmhmm”, “Ah-ha,” or “I see”),

Allow patients to speak uninterrupted at the beginning of the visit.

An often-cited study from 1984 demonstrated that it takes patients two minutes at most to explain their complaint, but physicians often interrupt between 18 to 23 seconds. 5 This can make the patient feel unheard and create missed opportunities to gather potentially important data. Interruptions include any statement that stops the patient's flow of thought.

Checking the EHR while the patient is talking can interfere with active listening, so avoid that if possible unless you've explained up front what you are doing (“I am just reviewing your recent labs so I can understand better what is going on”). If the patient drifts off on a tangent, gently redirect the conversation by saying, “That is interesting, but I really want to know more about [health item on agenda].”

3. ESTABLISH A SHARED AGENDA

After listening to the patient's chief complaint uninterrupted, it is imperative to pause and establish an agenda for the visit before gathering more history. To do this, ask “Is there something else you would like to discuss?” until the patient answers “No.” The term “something else” is preferable to “anything else” because it elicits more concerns without unduly lengthening the visit. 6 Eliciting patients' concerns up front will help you avoid “doorknob” moments when you are leaving the room and their hidden agenda emerges after you have already used your allotted time. Once all the patient's concerns are elicited, add your own items as well. Then, negotiate a shared agenda of what you will address at the current visit.

This can be difficult when patients present with multiple concerns that don't match up with the concerns you've identified, or when patients don't have realistic expectations about what you can address given the visit's time constraints. If this is the case, have an open conversation with the patient about the need to prioritize their concerns as well as yours. If less acute concerns cannot be addressed at the current visit, make sure the patient understands that they will be discussed at a follow-up visit, not ignored or put aside. If you have already set the stage for respectful communication, the patient will be more likely to understand and accept the agenda.

4. USE OPEN-ENDED QUESTIONS AND REFLECTIVE STATEMENTS

Open-ended questions and reflective statements demonstrate concern and empathy for the patient.

After introductions and small talk have taken place, starting the patient interview with an open-ended question such as “How can I help you today?” has been shown to have high impact on physician communication scores. 7 Use additional open-ended questions or statements throughout the encounter such as “Tell me more about that,” “What else have you noticed?” or “What are your thoughts about what is going on?”

Physicians are rated as more empathetic when they spend more time listening and making reflective statements. 8 Reflecting the patient's emotional state, either directly (“You are frustrated”) or indirectly (“It seems like that would be frustrating”), can show that you empathize with their feelings. Ignoring a patient's emotional cues out of a sense of haste can backfire, leading to longer encounters. It is best to acknowledge when a patient seems upset, angry, or anxious. Continue using positive nonverbal communication to demonstrate your compassion and concern, and to assure the patient that you are listening. If complaints about care arise, asking “What can I do to make this better?” can help bring the conflict to a mutually agreeable solution.

5. SOLIDIFY THE RELATIONSHIP WITH CLEAR EXPLANATIONS

Patients often come away from their visits not knowing the actual name of their diagnosis, the reasons for their new medications, possible side effects, or what to expect next. It is important to explain things clearly — your thoughts, diagnoses, treatment recommendations, and plan for follow up — and to write down all new diagnoses and medications to allow full patient engagement. Having printed educational materials you can give to the patient can be helpful, as long as patient literacy and educational levels are considered. Visit summaries filled out by staff and physicians can provide helpful follow-up information and instructions post-visit. Even if you have explained things thoroughly during the visit, patients are often overwhelmed with information and may not hear everything correctly. The teach-back method has been shown to improve patient outcomes. 9 You can preface it by saying, “I know we just went over a lot of information, so if you wouldn't mind, can you tell me what the next steps are, so I know I didn't miss anything?” This will ensure patient understanding and prevent further questions, calls, and re-explanations. In addition, at the end of every visit, ask “What questions do you have?” instead of “Do you have any questions?” as this encourages patient involvement.

POCKET GUIDE TO PATIENT COMMUNICATION

What about time constraints.

The time constraints of office visits are a concern shared by physicians and patients. Wait time and visit length can certainly affect patient satisfaction, but one study showed that what mattered more was the patient's perception of the amount of time spent with the physician. 10 The techniques discussed above will enhance patient satisfaction even if the actual time spent with the patient is short. To address the time constraints of office visits, set expectations early on. Be up-front with patients without dismissing complaints by saying, “I know we have a lot of things that we'd both like to discuss, and I want to be able to give each of them the appropriate time and attention. Why don't we schedule another visit in a few weeks to address the remainder of these concerns?”

AN IMPROVED PATIENT VIGNETTE

Let's take another look at the previous patient vignette, this time applying some of the skills and tips discussed above.

It has been a busy day in clinic, and your 10th patient of the morning is roomed 30 minutes late. The reason given for the visit is “preventive health,” but your rooming staff notifies you that the patient has a lot of other concerns to address as well. Before entering the room, you note that you are feeling pretty stressed from the busy morning and remind yourself that you want to be present for your patient. You take a deep breath before entering the room. When you step inside, you say hello to the patient and introduce yourself. You comment on the weather outside and thank the patient for waiting for you, since you are running behind. You then say, “The nurse mentioned you are here for an annual visit but also have a lot of concerns. How can I help you today?” The patient shares complaints regarding her wrists, hands, and knees. You then say, “Before I ask you more about that, is there something else you'd like to discuss today?” The patient nods and tells you about the constant headaches. You ask again if there's something else, and the patient tells you that is all. You tell the patient that you want to give adequate time to these concerns, so you would like to address the hand pain and headaches today and save the long-term knee issue and annual visit for next time. After finishing your history and physical exam, you come up with a plan and write down instructions for the patient. Before saying goodbye, you tell the patient, “Thank you so much for bringing these concerns to me. I hope we can work together to figure out these issues.”

START WITH SMALL CHANGES

These small changes in communication can have a big impact on the patient experience. Just as we advise our patients who are trying to make major lifestyle changes to focus on small steps, we too should work on incorporating small changes one at a time, using your own style and personality, until it starts to feel natural. Don't worry if you slip back into old ways of doing things; just start again with the next patient. We have included a table of the most pertinent tips and phrases, which can be printed as a pocket card . As you seek to improve your communication skills, we hope that your patients will be happier and have better outcomes and that you will experience higher satisfaction.

Stewart MA. Effective physician-patient communication and health outcomes: a review. CMAJ . 1995;152(9):1423-1433.

Von Korff M, Gruman J, Schaefer J, Curry SJ, Wagner EH. Collaborative management of chronic illness. Ann Intern Med . 1997;127(12):1097-1102.

Morris J, Hotko B, Bates M. The CG CAHPS Handbook: A Guide to Improve Patient Experience and Clinical Outcomes . Studer Group and Fire Starter Publishing; 2015.

Mauksch LB, Dugdale DC, Dodson S, Epstein R. Relationship, communication, and efficiency in the medical encounter: creating a clinical model from a literature review. Arch Intern Med . 2008;168(13):1387-1395.

Beckman HB, Frankel RM. The effect of physician behavior on the collection of data. Ann Intern Med . 1984;101(5):692-696.

Heritage J, Robinson JD, Elliott MN, Beckett M, Wilkes M. Reducing patients’ unmet concerns in primary care: the difference one word can make. J Gen Intern Med . 2007;22(10):1429-1433.

Saad Riegels N, Asher E, Cartright JR, et al.; Listening beyond auscultating: a quality initiative to improve communication scores in the Hospital Consumer Assessment of Health Care Practitioners and Systems survey. Perm J . 2018;22:16-187.

Pollak KI, Alexander SC, Tulsky JA, et al.; Physician empathy and listening: associations with patient satisfaction and autonomy. J Am Board Fam Med . 2011;24(6):665-672.

Ha Dinh TT, Bonner A, Clark R, Ramsbotham J, Hines S. The effectiveness of the teach-back method on adherence and self-management in health education for people with chronic disease: a systematic review. JBI Database System Rev Implement Rep . 2016;14(1):210-247.

Cape J. Consultation length, patient-estimated consultation length, and satisfaction with the consultation. Br J Gen Pract . 2002;52(485):1004-1006.

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More in FPM

Communicating with Patients

Open Resources for Nursing (Open RN)

Therapeutic communication is at the foundation of the nurse-client relationship. It is different than the conversations you have with friends, peers, family, and colleagues. Therapeutic communication has a specific purpose within the healthcare context. It is intended to develop an effective interpersonal nurse-client relationship that supports the client’s wellbeing and ensures holistic, client-centered, quality care.

Therapeutic communication is further defined as, “The purposeful, interpersonal information-transmitting process through words and behaviors based on both parties’ knowledge, attitudes, and skills, which leads to patient understanding and participation.” [1] Therapeutic communication techniques used by nurses have roots going back to Florence Nightingale, who insisted on the importance of building trusting relationships with patients and believed in the therapeutic healing that resulted from nurses’ presence with patients. [2] Since then, several professional nursing associations have highlighted therapeutic communication as one of the most vital elements in nursing.

Read an example of a nursing student effectively using therapeutic communication with patients in the following box.

An Example of Nursing Student Using Therapeutic Communication

Photo showing a nurse smiling at a patient in a wheel chair

Ms. Z. is a nursing student who enjoys interacting with patients. When she goes to patients’ rooms, she greets them and introduces herself and her role in a calm tone. She kindly asks patients about their problems and notices their reactions. She does her best to solve their problems and answer their questions. Patients perceive that she wants to help them. She treats patients professionally by respecting boundaries and listening to them in a nonjudgmental manner. She addresses communication barriers and respects patients’ cultural beliefs. She notices patients’ health literacy and ensures they understand her messages and patient education. As a result, patients trust her and feel as if she cares about them, so they feel comfortable sharing their health care needs with her. [3] , [4]

Active Listening and Attending Behaviors

Listening is obviously an important part of communication. There are three main types of listening: competitive, passive, and active. Competitive listening happens when we are focused on sharing our own point of view instead of listening to someone else. Passive listening occurs when we are not interested in listening to the other person and we assume we understand what the person is communicating correctly without verifying. During active listening , we are communicating verbally and nonverbally that we are interested in what the other person is saying while also actively verifying our understanding with the speaker. For example, an active listening technique is to restate what the person said and then verify our understanding is correct. This feedback process is the main difference between passive listening and active listening. [5]

Touch is a powerful way to professionally communicate caring and empathy if done respectfully while being aware of the patient’s cultural beliefs. Nurses commonly use professional touch when assessing, expressing concern, or comforting patients. For example, simply holding a patient’s hand during a painful procedure can be very effective in providing comfort. See Figure 2.7 [6] for an image of a nurse using touch as a therapeutic technique when caring for a patient.

Photo showing nurse touching infant in incubator

Therapeutic Techniques

Therapeutic communication techniques are specific methods used to provide patients with support and information while focusing on their concerns. Nurses assist patients to set goals and select strategies for their plan of care based on their needs, values, skills, and abilities. It is important to recognize the autonomy of the patient to make their own decisions, maintain a nonjudgmental attitude, and avoid interrupting. Depending on the developmental stage and educational needs of the patient, appropriate terminology should be used to promote patient understanding and rapport. When using therapeutic communication , nurses often ask open-ended statements and questions, repeat information, or use silence to prompt patients to work through problems on their own. [7] Table 2.3a describes a variety of therapeutic communication techniques. [8]

Table 2.3a Therapeutic Communication Techniques

In addition to the therapeutic techniques listed in Table 2.3a, nurses and nursing students should genuinely communicate with empathy. Communicating honestly, genuinely, and authentically is powerful. It opens the door to creating true connections with others. [9] Communicating with empathy has also been described as providing “unconditional positive regard.” Research has demonstrated that when health care teams communicate with empathy, there is improved patient healing, reduced symptoms of depression, and decreased medical errors. [10]

Nurses and nursing students must be aware of potential barriers to communication. In addition to considering common communication barriers discussed in the previous section, there are several nontherapeutic responses to avoid. These responses often block the patient’s communication of their feelings or ideas. See Table 2.3b for a description of nontherapeutic responses. [11]

Table 2.3b Nontherapeutic Responses

Strategies for Effective Communication

In addition to using therapeutic communication techniques, avoiding nontherapeutic responses, and overcoming common barriers to communication, there are additional strategies for promoting effective communication when providing patient-centered care. Specific questions to ask patients are as follows:

What concerns do you have about your plan of care?
What questions do you have about your medications?
Did I answer your question(s) clearly or is there additional information you would like? [12]

Listen closely for feedback from patients. Feedback provides an opportunity to improve patient understanding, improve the patient-care experience, and provide high-quality care. Other suggestions for effective communication with hospitalized patients include the following:

Round with the providers and read progress notes from other health care team members to ensure you have the most up-to-date information about the patient’s treatment plan and progress. This information helps you to provide safe patient care as changes occur and also to accurately answer the patient’s questions.
Review information periodically with the patient to improve understanding.
Use patient communication boards in their room to set goals and communicate important reminders with the patient, family members, and other health care team members. This strategy can reduce call light usage for questions related to diet and activity orders and also gives patients and families the feeling that they always know the current plan of care. However, keep patient confidentiality in mind regarding information to publicly share on the board that visitors may see.
Provide printed information on medical procedures, conditions, and medications. It helps patients and family members to have multiple ways to provide information. [13]

Adapting Your Communication

When communicating with patients and family members, take note of your audience and adapt your message based on their characteristics such as age, developmental level, cognitive abilities, and any communication disorders. For patients with language differences, it is vital to provide trained medical interpreters when important information is communicated.

Adapting communication according to the patient’s age and developmental level includes the following strategies:

When communicating with children, speak calmly and gently. It is often helpful to demonstrate what will be done during a procedure on a doll or stuffed animal. To establish trust, try using play or drawing pictures.
When communicating with adolescents, give freedom to make choices within established limits.
When communicating with older adults, be aware of potential vision and hearing impairments that commonly occur and address these barriers accordingly. For example, if a patient has glasses and/or hearing aids, be sure these devices are in place before communicating. See the following box for evidence-based strategies for communication with patients who have impaired hearing and vision. [14]

Media Attributions

beautiful african nurse taking care of senior patient in wheelch
Abdolrahimi, M., Ghiyasvandian, S., Zakerimoghadam, M., & Ebadi, A. (2017). Therapeutic communication in nursing students: A Walker & Avant concept analysis. Electronic Physician, 9 (8), 4968–4977. https://doi.org/10.19082/4968 ↵
Karimi, H., & Masoudi Alavi, N. (2015). Florence Nightingale: The mother of nursing. Nursing and Midwifery Studies, 4 (2), e29475. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4557413/ . ↵
“ beautiful african nurse taking care of senior patient in wheelchair ” by agilemktg1 is in the Public Domain ↵
This work is a derivative of Human Relations by LibreTexts and is licensed under CC BY-NC-SA 4.0 ↵
Flickr - Official U.S. Navy Imagery - A nurse examines a newborn baby..jpg ” by MC2 John O'Neill Herrera/ U.S. Navy is in the Public Domain ↵
American Nurse. (n.d.). Therapeutic communication techniques . https://www.myamericannurse.com/therapeutic-communication-techniques/ ↵
Balchan, M. (2016). The Magic of Genuine Communication. http://michaelbalchan.com/communication/ ↵
Morrison, E. (2019). Empathetic Communication in Healthcare. https://www.cibhs.org/sites/main/files/file-attachments/empathic_communication_in_healthcare_workbook.pdf?1594162691 ↵
Burke, A. (2021). Therapeutic Communication: NCLEX-RN. https://www.registerednursing.org/nclex/therapeutic-communication/ ↵
Smith, L. L. (2018, June 12). Strategies for effective patient communication. American Nurse . https://www.myamericannurse.com/strategies-for-effective-patient-communication/ ↵
Smith, L. L. (2018, June 12). Strategies for effective patient communication. American Nurse. https://www.myamericannurse.com/strategies-for-effective-patient-communication/ ↵
Butcher, H., Bulechek, G., Dochterman, J., & Wagner, C. (2018). Nursing interventions classification (NIC) . Elsevier, pp. 115-116 ↵

About the Author

name: Open Resources for Nursing (Open RN)

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2.3 Communicating with Patients

Open Resources for Nursing (Open RN)

Therapeutic communication is a type of professional communication used by nurses with patients and defined as, “The purposeful, interpersonal information-transmitting process through words and behaviors based on both parties’ knowledge, attitudes, and skills, which leads to patient understanding and participation.” [1] Therapeutic communication techniques used by nurses have roots going back to Florence Nightingale, who insisted on the importance of building trusting relationships with patients and believed in the therapeutic healing that resulted from nurses’ presence with patients. [2] Since then, several professional nursing associations have highlighted therapeutic communication as one of the most vital elements in nursing.

Read an example of a nursing student effectively using therapeutic communication with patients in the following box.

An Example of Nursing Student Using Therapeutic Communication

Active Listening and Attending Behaviors

Therapeutic Techniques

Table 2.3a Therapeutic Communication Techniques

Table 2.3b Nontherapeutic Responses

Strategies for Effective Communication

What concerns do you have about your plan of care?
What questions do you have about your medications?
Did I answer your question(s) clearly or is there additional information you would like? [12]

Round with the providers and read progress notes from other health care team members to ensure you have the most up-to-date information about the patient’s treatment plan and progress. This information helps you to provide safe patient care as changes occur and also to accurately answer the patient’s questions.
Review information periodically with the patient to improve understanding.
Use patient communication boards in their room to set goals and communicate important reminders with the patient, family members, and other health care team members. This strategy can reduce call light usage for questions related to diet and activity orders and also gives patients and families the feeling that they always know the current plan of care. However, keep patient confidentiality in mind regarding information to publicly share on the board that visitors may see.
Provide printed information on medical procedures, conditions, and medications. It helps patients and family members to have multiple ways to provide information. [13]

Adapting Your Communication

Adapting communication according to the patient’s age and developmental level includes the following strategies:

When communicating with children, speak calmly and gently. It is often helpful to demonstrate what will be done during a procedure on a doll or stuffed animal. To establish trust, try using play or drawing pictures.
When communicating with adolescents, give freedom to make choices within established limits.
When communicating with older adults, be aware of potential vision and hearing impairments that commonly occur and address these barriers accordingly. For example, if a patient has glasses and/or hearing aids, be sure these devices are in place before communicating. See the following box for evidence-based strategies for communication with patients who have impaired hearing and vision. [14]

Strategies for Communicating with Patients with Impaired Hearing and Vision

Impaired Hearing

Gain the patient’s attention before speaking (e.g., through touch)
Minimize background noise
Position yourself 2-3 feet away from the patient
Facilitate lip-reading by facing the patient directly in a well-lit environment
Use gestures, when necessary
Listen attentively, allowing the patient adequate time to process communication and respond
Refrain from shouting at the patient
Ask the patient to suggest strategies for improved communication (e.g., speaking toward better ear and moving to well-lit area)
Face the patient directly, establish eye contact, and avoid turning away mid sentence
Simplify language (i.e., do not use slang but do use short, simple sentences), as appropriate
Note and document the patient’s preferred method of communication (e.g., verbal, written, lip-reading, or American Sign Language) in plan of care
Assist the patient in acquiring a hearing aid or assistive listening device
Refer to the primary care provider or specialist for evaluation, treatment, and hearing rehabilitation [15]

Impaired Vision

Identify yourself when entering the patient’s space
Ensure the patient’s eyeglasses or contact lenses have current prescription, are cleaned, and stored properly when not in use
Provide adequate room lighting
Minimize glare (i.e., offer sunglasses or draw window covering)
Provide educational materials in large print
Apply labels to frequently used items (i.e., mark medication bottles using high-contrasting colors)
Read pertinent information to the patient
Provide magnifying devices
Provide referral for supportive services (e.g., social, occupational, and psychological) [16]

Patients with communication disorders require additional strategies to ensure effective communication. For example, aphasia is a communication disorder that results from damage to portions of the brain that are responsible for language. Aphasia usually occurs suddenly, often following a stroke or head injury, and impairs the patient’s expression and understanding of language. Global aphasia is caused by injuries to multiple language-processing areas of the brain, including those known as Wernicke’s and Broca’s areas. These brain areas are particularly important for understanding spoken language, accessing vocabulary, using grammar, and producing words and sentences. Individuals with global aphasia may be unable to say even a few words or may repeat the same words or phrases over and over again. They may have trouble understanding even simple words and sentences. [17]

The most common type of aphasia is Broca's aphasia . People with Broca’s aphasia often understand speech and know what they want to say, but frequently speak in short phrases that are produced with great effort. For example, they may intend to say, “I would like to go to the bathroom,” but instead the words, “Bathroom, Go,” are expressed. They are often aware of their difficulties and can become easily frustrated. See the hyperlink in the box below for evidence-based strategies to enhance communication with a person with impaired speech. [18]

Strategies to Improve Communication with Patients with Impaired Speech

Modify the environment to minimize excess noise and decrease emotional distress
Phrase questions so the patient can answer using a simple “Yes” or “No,” being aware that patients with expressive aphasia may provide automatic responses that are incorrect
Monitor the patient for frustration, anger, depression, or other responses to impaired speech capabilities
Provide alternative methods of speech communication (e.g., writing tablet, flash cards, eye blinking, communication board with pictures and letters, hand signals or gestures, and computer)
Adjust your communication style to meet the needs of the patient (e.g., stand in front of the patient while speaking, listen attentively, present one idea or thought at a time, speak slowly but avoid shouting, use written communication, or solicit family’s assistance in understanding the patient’s speech)
Ensure the call light is within reach and central call light system is marked to indicate the patient has difficulty with speech
Repeat what the patient said to ensure accuracy
Instruct the patient to speak slowly
Collaborate with the family and a speech therapist to develop a plan for effective communication [19]

Maintaining Patient Confidentiality

When communicating with patients, their friends, their family members, and other members of the health care team, it is vital for the nurse to maintain patient confidentiality. The Health Insurance Portability and Accountability Act (HIPAA) provides standards for ensuring privacy of patient information that are enforceable by law. Nurses must always be aware of where and with whom they share patient information. For example, information related to patient care should not be discussed in public areas, paper charts must be kept in secure areas, computers must be logged off when walked away from, and patient information should only be shared with those directly involved in patient care. For more information about patient confidentiality, see the “ Legal Considerations & Ethics ” section in the “Scope of Practice” chapter.

Read more information about the Health Insurance Portability and Accountability Act of 1996 (HIPAA) .

Abdolrahimi, M., Ghiyasvandian, S., Zakerimoghadam, M., & Ebadi, A. (2017). Therapeutic communication in nursing students: A Walker & Avant concept analysis. Electronic Physician, 9 (8), 4968–4977. https://doi.org/10.19082/4968 ↵
Karimi, H., & Masoudi Alavi, N. (2015). Florence Nightingale: The mother of nursing. Nursing and Midwifery Studies, 4 (2), e29475. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4557413/ . ↵
“ beautiful african nurse taking care of senior patient in wheelchair ” by agilemktg1 is in the Public Domain ↵
This work is a derivative of Human Relations by LibreTexts and is licensed under CC BY-NC-SA 4.0 ↵
Flickr - Official U.S. Navy Imagery - A nurse examines a newborn baby..jpg ” by MC2 John O'Neill Herrera/ U.S. Navy is in the Public Domain ↵
American Nurse. (n.d.). Therapeutic communication techniques . https://www.myamericannurse.com/therapeutic-communication-techniques/ ↵
Balchan, M. (2016). The Magic of Genuine Communication. http://michaelbalchan.com/communication/ ↵
Morrison, E. (2019). Empathetic Communication in Healthcare. https://www.cibhs.org/sites/main/files/file-attachments/empathic_communication_in_healthcare_workbook.pdf?1594162691 ↵
Burke, A. (2021). Therapeutic Communication: NCLEX-RN. https://www.registerednursing.org/nclex/therapeutic-communication/ ↵
Smith, L. L. (2018, June 12). Strategies for effective patient communication. American Nurse . https://www.myamericannurse.com/strategies-for-effective-patient-communication/ ↵
Smith, L. L. (2018, June 12). Strategies for effective patient communication. American Nurse. https://www.myamericannurse.com/strategies-for-effective-patient-communication/ ↵
Butcher, H., Bulechek, G., Dochterman, J., & Wagner, C. (2018). Nursing interventions classification (NIC) . Elsevier, pp. 115-116 ↵
Butcher, H., Bulechek, G., Dochterman, J., & Wagner, C. (2018 ). Nursing interventions classification (NIC) . Elsevier, pp. 115-116 ↵
National Institute on Deafness and Other Communication Disorders (NIDCD). (2017, March 6). Aphasia. https://www.nidcd.nih.gov/health/aphasia ↵
Butcher, H., Bulechek, G., Dochterman, J., & Wagner, C. (2018). Nursing interventions classification (NIC) . Elsevier, pp. 115-116. ↵
Butcher, H., Bulechek, G., Dochterman, J., & Wagner, C. (2018). Nursing interventions classification (NIC). Elsevier, pp. 115-116. ↵

Process by which we are communicating verbally and nonverbally that we are interested in what the other person is saying while also actively verifying our understanding with the speaker.

Techniques that encourage patients to explore feelings, problem solve, and cope with responses to medical conditions and life events.

The purposeful, interpersonal information transmitting process through words and behaviors based on both parties’ knowledge, attitudes, and skills, which leads to patient understanding and participation.

Responses to patients that block communication, expression of emotion, or problem solving.

A communication disorder that results from damage to portions of the brain that are responsible for language.

A type of aphasia that results from damage to extensive portions of the language areas of the brain. Individuals with global aphasia have severe communication difficulties and may be extremely limited in their ability to speak or comprehend language. They may be unable to say even a few words or may repeat the same words or phrases over and over again. They may have trouble understanding even simple words and sentences.

A type of aphasia where patients understand speech and know what they want to say, but frequently speak in short phrases that are produced with great effort. People with Broca's aphasia typically understand the speech of others fairly well. Because of this, they are often aware of their difficulties and can become easily frustrated.

Standards for ensuring privacy of patient information that are enforceable by law.

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3.14: Therapeutic Communication Techniques

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Page ID 49361

Nilgun Ulutasdemir Ed. and contributing authors

Maureen Nokuthula Sibiya
Gümüşhane University via IntechOpen

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Table 1 gives an overview of therapeutic communication techniques and provides examples of each technique [ 10 , 13 ].

-Therapeutic communication techniques.

Patient-Centered Communication: Basic Skills

Affiliation.

1 United Arab Emirates University College of Medicine and Health Sciences, Al Ain, Abu Dhabi, United Arab Emirates.
PMID: 28075109

Communication skills needed for patient-centered care include eliciting the patient's agenda with open-ended questions, especially early on; not interrupting the patient; and engaging in focused active listening. Understanding the patient's perspective of the illness and expressing empathy are key features of patient-centered communication. Understanding the patient's perspective entails exploring the patient's feelings, ideas, concerns, and experience regarding the impact of the illness, as well as what the patient expects from the physician. Empathy can be expressed by naming the feeling; communicating understanding, respect, and support; and exploring the patient's illness experience and emotions. Before revealing a new diagnosis, the patient's prior knowledge and preferences for the depth of information desired should be assessed. After disclosing a diagnosis, physicians should explore the patient's emotional response. Shared decision making empowers patients by inviting them to consider the pros and cons of different treatment options, including no treatment. Instead of overwhelming the patient with medical information, small chunks of data should be provided using repeated cycles of the "ask-tell-ask" approach. Training programs on patient-centered communication for health care professionals can improve communication skills.

Attitude of Health Personnel*
Clinical Competence*
Communication
Patient Compliance / psychology
Patient Education as Topic / methods*
Patient Satisfaction
Patient-Centered Care / methods*
Quality Assurance, Health Care

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Week 3: Communication Part A

Unit Learning Outcomes:

At the end of this chapter, the learner will:

Discuss effective therapeutic communication and professional communication.
Demonstrate therapeutic communication skills to communicate with patients and their families.

Overview of this chapter

This chapter includes information related to therapeutic communication and communication skills to care for your patients and families. This is the first section focuses on techniques to apply effective therapeutic communication and professional communication. The second part includes different therapeutic communication tools, documentation guidelines and different types of communication.

1. Introduction of Communication

When you think of communication, talking to another person or texting them might come to mind first. However, while talking and texting are methods of communication delivery, they are not representative of a comprehensive definition of communication.

A more comprehensive understanding of communication refers to the sharing of information, ideas, and feelings, typically aimed at mutual understanding . In this way, you must consider the sender, the recipient, and the transaction. Simply put, the sender is the person sharing the message, the recipient is the person receiving and interpreting the message, and the transaction is the way that the message is delivered and the factors that influence the context and environment of the communication. As you can see, communication is a complex process. It involves more than just what you say and takes many forms as reflected in Figure 3.1 .

Figure 3.1 : Forms of communication.

There are three types of communication :

Verbal communication is oral communication that happens through spoken words, sounds, vocal intonation, and pace. It can occur face-to-face, one-on-one, or in groups, over the telephone, or video conferencing. As a nurse, you will engage in verbal communication with clients, families, colleagues, and interprofessional teams.
Non-verbal communication is a type of communication that occurs through facial expressions, eye contact, gestures, and body positions and movements . As a nurse, you will learn that your non-verbal communication is important because it can both reinforce or contradict what you say verbally. Additionally, non-verbal communication is used more often than verbal communication. Thus, you must become aware of your non-verbal communication.
Written communication is a type of communication that occurs through written words, symbols, pictures, and diagrams . You are probably familiar with some informal, written types of communication, such as texting or emailing someone, posting a picture on Instagram, or using an emoji in Twitter. You may also have engaged in more scholarly forms of written communication such as letters and papers. As a nurse, written communication also involves documentation notes and scholarly writing like essays, peer-reviewed publications, protocols, practice standards, and best practice guidelines. You may not be familiar with some of these types of written communication yet, but you will become more acquainted with them over the course of your nursing program.

Professional Communication

Exercises: Check Your Understanding

II. Communication in Professional Practice

A. Therapeutic communication is at the foundation of the nurse-client relationship as reflected in Figure 3.2 . It is different than the conversations you have with friends, peers, family, and colleagues. Therapeutic communication has a specific purpose within the healthcare context. It is intended to develop an effective interpersonal nurse-client relationship that supports the client’s wellbeing and ensures holistic, client-centered, quality care.

The word “ therapeutic ” is related to the word therapy: it means having a restorative and healing effect on the mind and body as well as doing no harm. It is important to consider how you communicate and how this affects the client.

Point of Consideration

Learning Therapeutic Communication

Therapeutic communication is a learned activity that requires knowledge and continued practice and self-reflection.

Exercises: Therapeutic Communication/nontherapeutic Communication

Watch the first part of the video “Nontherapeutic vs therapeutic communication” https://www.youtube.com/watch?v=Ik_hwMHVHM4

Students to work independently or in groups to answer the following questions(#3).
Get back together and discuss the students’ responses.
Discuss appropriate therapeutic techniques to correct the observed nurse patient interaction. Explore students’ thoughts and reflections.
Watch the second part of the video demonstrating appropriate therapeutic communication.
Remember that communication in the nurse-patient relationship should focus on the patient and patient needs, not on the nurse or an activity in which the nurse is engaged.

III. Communication Strategies

There are many communication strategies that should be used to facilitate therapeutic communication . See Table 3.1 for a list of these strategies and considerations and examples on how they build the therapeutic relationship.

Table 3.1 : Communication strategies.

Film Clip 3.4 : Demonstration of how to avoid false reassurance. http://pressbooks.library.ryerson.ca/communicationnursing/wp-content/uploads/sites/99/2020/06/How-to-Avoid-False-Reassurance.mp4?_=2

3. Share your take-aways from this exercise to the class

IV. Barriers to Effective communication:

Effective communication is an important part of nursing skill. There are several barriers for effective communication. Some of those example are language, culture, noise, perception, special needs such as hearing/vision difficulty and medication. For more information: https://med.libretexts.org/Bookshelves/Nursing/Nursing_(Ulutasdemir)/03%3A_Effective_Communication_in_Nursing/3.07%3A_Barriers_to_Effective_Communication

Nurses optimize communication through active listening to patients and families. Sometimes there are invisible needs of those around us.

1. View the following video and reflect on the often invisible needs of those around us and the difference we can make by creating caring human connections. Encourage students to verbalize their thoughts, impressions, feelings, etc.

View the video: Empathy: The Human Connection to Patient Care: https://youtu.be/cDDWvj_q-o8?si=duFev4pzDJAk7u5E

2. Communicating with Patients: https://batch.libretexts.org/print/url=https://med.libretexts.org/Bookshelves/Nursing/Nursing_Fundamentals_(OpenRN)/02%3A_Communication/2.03%3A_Communicating_with_Patients.pdf

What strategies would you implement when communicating with patients with impaired hearing and vision?
List therapeutic techniques and non-therapeutic responses of communication

Review: Documentation/charting guidelines:

Please review Documentation: Using Technology to Access Information : https://batch.libretexts.org/print/url=https://med.libretexts.org/Bookshelves/Nursing/Nursing_Fundamentals_(OpenRN)/02%3A_Communication/2.05%3A_Documentation.pdf

Review Documentation/charting guidelines for Montgomery college nursing students. You can find this document in the Blackboard under this week content.

Review sample and discuss importance of different types of notes.

Exercise: SAMPLE DOCUMENTATION

Sample Documentation of Expected Findings

Patient denies cough, chest pain, or shortness of breath. Denies past or current respiratory illnesses or diseases. Symmetrical anterior and posterior thorax. Anteroposterior-transverse ratio is 1:2. Respiratory rate is 16 breaths/minute, unlabored, regular, and inaudible through the nose. No retractions, accessory muscle use, or nasal flaring. Chest rise and fall are equal bilaterally. Skin is pink, warm, and dry. No crepitus, masses, or tenderness upon palpation of anterior and posterior chest. Lung sounds clear bilaterally in all lobes anteriorly and posteriorly. No adventitious sounds. SpO2 saturation 99% on room air.

Sample Documentation of Unexpected Findings

Patient reports shortness of breath for five to six hours. Patient has labored breathing at rest. Nail beds are cyanotic. Respiratory rate is tachypneic at 32/minute with neck and abdominal accessory muscle use. Lung expansion is symmetrical. Pursed-lip breathing noted with intermittent productive cough. Reports coughing up blood-tinged green sputum for two days. Anterior and posterior chest walls have no tenderness, masses, or crepitus upon palpation. On auscultation bilateral coarse crackles over lung bases. Expiratory wheezes are audible and heard with stethoscope scattered throughout lung fields. Pulse oximetry 93% on room air.

Exercises : Practice Writing Nursing Documentation

Patient Scenario

Mr. Hernandez is a 47-year-old patient admitted to the neurological trauma floor as the result of a motor vehicle accident two days ago. The patient sustained significant facial trauma in the accident and his jaw is wired shut. His left eye is currently swollen, and he had significant bruising to the left side of his face. The nurse completes a visual assessment and notes that the patient has normal extraocular movement, peripheral vision, and pupillary constriction bilaterally.

Additional assessment reveals that Mr. Hernandez also sustained a fracture of the left arm and wrist during the accident. His left arm is currently in a cast and sling. He has normal movement and sensation with his right hand.

Mrs. Hernandez is present at the patient’s bedside and has provided additional information about the patient. She reports that Mr. Hernandez’s primary language is Spanish but that he understands English well. He has a bachelor’s degree in accounting and owns his own accounting firm. He has a history of elevated blood pressure, but is otherwise healthy.

The nurse notes that the patient’s jaw is wired and he is unable to offer a verbal response. He does understand English well, has appropriate visual acuity, and is able to move his right hand and arm.

Based on the assessment information that has been gathered, the nurse plans several actions to enhance communication. Adaptive communication devices such as communication boards, symbol cards, or electronic messaging systems will be provided. The nurse will eliminate distractions such as television and hallway noise to decrease sources of additional stimuli in the communication experience.

Practice writing admission nurse’s note. Share your notes with the class for further discussion.

Activity: Check Your Understanding

What are your key-take away from today? Share your thoughts with the class

Assignment

Review assignment instructions in the Blackboard

Nurses and their Specialties
Reflection on “professionalism in nursing”

V. Recommended Resources

Read the American Nurses Association’s Principles for Nursing Documentation .

COMMUNICATION INTRODUCTION: https://www.ncbi.nlm.nih.gov/books/NBK591817/

References and Attributions

1.Professional Communication: Retrieved from: http://Introduction: Therapeutic Communication. Creative Commons Attribution-NonCommercial 4.0 International License

2. Communicating with Patients: Retrieved from: https://batch.libretexts.org/print/url=https://med.libretexts.org/Bookshelves/Nursing/Nursing_Fundamentals_(OpenRN)/02%3A_Communication/2.03%3A_Communicating_with_Patients.pdf

The Novice Nurse's Guide to Professional Nursing Practice Copyright © by Kunjamma George, PhD, RN, CNE and Raquel Bertiz, PhD, RN, CNE, CHSE-A is licensed under a Creative Commons Attribution-NonCommercial-ShareAlike 4.0 International License , except where otherwise noted.

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Therapeutic Communication Techniques NCLEX Practice Quiz & Reviewer (50 Questions)

Welcome to your reviewer and NCLEX practice quiz guide about therapeutic communication techniques in nursing ! This nursing test bank tests your knowledge and understanding of therapeutic communication. This quiz aims to help student nurses how to answer therapeutic communication questions in the NCLEX .

Therapeutic Communication Techniques in Nursing Practice Quiz

In this section are the NCLEX practice questions to help you familiarize yourself with therapeutic communication items. Included in this nursing test bank are 50 questions divided into two parts. We hope that this practice quiz will help you understand the essential elements and concepts of therapeutic communication.

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Therapeutic Communication in Nursing

The guide below is your reviewer of the concepts of therapeutic communication in nursing. We’ve made it as condense as possible by including only the key facts to help you refresh your memory !

Learning therapeutic communication techniques is an important skill that nurses should possess since communication is an integral part of being a nurse . This is a study guide about the basic principles of therapeutic communication, its purpose, differences in verbal and nonverbal communication, and lastly, the different therapeutic communication techniques.

What is Therapeutic Communication?

Therapeutic communication is an interpersonal interaction between the nurse and the client during which the nurse focuses on the client’s specific needs to promote an effective exchange of information. Skilled use of therapeutic communication techniques helps the nurse understand and empathize with the client’s experience.

Goals of Therapeutic Communication

Therapeutic communication can help nurses to accomplish many goals:

Establish a therapeutic nurse-client relationship.
Identify the most important client concern at that moment (the client-centered goal).
Assess the client’s perception of the problem as it unfolds; this includes detailed actions (behaviors and messages) of the people involved and the client’s thoughts and feelings about the situation, others, and self.
Facilitate the client’s expression of emotion.
Teach the client and the family necessary self-care skills.
Recognize the client’s needs.
Implement interventions designed to address the client’s needs.
Guide the client toward identifying the plan of action to a satisfying and socially acceptable resolution.

Verbal Communication Skills

Verbal communication consists of the words a person uses to speak to one or more listeners.

Using concrete messages. The nurse should use words that are as clear as possible when speaking to the client so that the client can understand the message; in a concrete message, the words are explicit and need no interpretation, the speaker uses nouns instead of pronouns; concrete questions are clear, direct, and easy to understand.
Using therapeutic communication techniques. The choice of technique depends on the intent of the interaction and the client’s ability to communicate verbally; overall, the nurse selects techniques that facilitate the interaction and enhance communication between client and nurse.
Avoiding nontherapeutic communication. In contrast, there are many nontherapeutic techniques that nurses should avoid; these responses cut off communication and make it more difficult for the interaction to continue.
Interpreting signals or cues. To understand what a client means, the nurse watches and listens carefully for cues; cues are verbal or nonverbal messages that signal keywords or issues for the client; finding cues is a function of active listening often, cue words introduced by the client can help the nurse to know what to ask next or how to respond to the client.

Nonverbal Communication Skills

Therapeutic communication also involves nonverbal communication is behavior that a person exhibits while delivering verbal content.

Facial expression. The human face produces the most visible, complex, and sometimes confusing nonverbal messages; facial movements connect with words to illustrate meaning; this connection demonstrates the speaker’s internal dialogue.
Body language. Body language (gestures, postures, movements, and body positions) is a nonverbal form of communication; closed body positions, such as crossed legs or arms folded across the chest, indicate that the interaction might threaten the listener who is defensive or not accepting; a better, more accepting body position is to sit facing the client with both feet on the floor, knees parallel, hands at the side of the body, and legs uncrossed or crossed only at the ankle.
Vocal cues. Vocal cues are nonverbal sound signals transmitted along with the content: voice volume, tone, pitch, intensity, emphasis, speed, and pauses augment the sender’s message; volume, the loudness of the voice, can indicate anger, fear , happiness, or deafness; tone can indicate whether someone is relaxed, agitated, or bored; pitch varies from shrill and high to low and threatening; intensity is the power, severity, and strength behind the words; emphasis refers to accents on words or phrases that highlight the subject, and speed is the number of words spoken per minute.
Eye contact. The eyes have been called the mirror of the soul because they often reflect our emotions; eye contact, looking into the other person’s eyes during communication, is used to assess the other person and the environment and to indicate whose turn it is to speak; it increases during listening but decreases while speaking.

Therapeutic Communication Techniques

Choosing the appropriate therapeutic communication technique is critical in establishing and maintaining the nurse-patient relationship . These techniques are discussed below:

Non-Therapeutic Communication

Non-Therapeutic communication involves words, phrases, actions, and tones that make patients feel uncomfortable, increase their stress, and worsen their mental and even physical wellbeing.

Tips in Answering Therapeutic Communication Questions

Getting the client’s response or the way you communicate with them is a mainstay of the NCLEX. The psychosocial focus of nursing is a central thread throughout all of the clinical areas. Effective communication is an essential way to establish therapeutic relationships. These types of questions are relatively easy to answer especially if you read these five principles on answering therapeutic communication questions:

1. Responses that focus on the client’s feelings

Most clients sometimes find it difficult to express their feelings whether they have a terminal illness, are pregnant, or are scheduled for surgery . Any nursing response that elicits these feelings would be therapeutic. Listen and attend to those client cues. For example, the question below:

SITUATION: A 20-year-old college student is admitted to the medical ward because of sudden onset of paralysis of both legs. Nikki reveals that the boyfriend has been pressuring her to engage in premarital sex. The most therapeutic response by the nurse is: a. “I can refer you to a spiritual counselor if you like.” b. “You shouldn’t allow anyone to pressure you into sex.” c. “It sounds like this problem is related to your paralysis.” d. “How do you feel about being pressured into sex by your boyfriend?”

For this question, the correct answer is D. The statement focuses on expressing feelings and is therapeutic. Option A is not therapeutic because the nurse passes the responsibility to the counselor. Option B. is giving advice is not therapeutic as it virtually terminates the conversation. Option C is not also therapeutic because it confronts the underlying cause.

When it seems as if clients would like to discuss fears, concerns, angry feelings, then encourage their expression.

2. Responses that are honest and direct

The nurse must be honest with her responses to encourage trust and build a therapeutic relationship. Honesty will support a trustful and firm relationship.

Situation: An old woman was brought for evaluation due to the hospital for evaluation due to increasing forgetfulness and limitations in daily function. She says to the nurse who offers her breakfast, “Oh no, I will wait for my husband. We will eat together” The therapeutic response by the nurse is: a. “Your husband is dead. Let me serve you your breakfast.” b. “I’ve told you several times that he is dead. It’s time to eat.” c. “You’re going to have to wait a long time.” d. “What made you say that your husband is alive?

The correct answer is option A. Since the client has signs of dementia , she should be reoriented to reality and focused on here and now. Option B is not a helpful approach because of the short-term memory of the client. Option C indicates a pompous response. Option D is a cognitive limitation of the client that makes the client incapable of explaining.

3. Responses that involve active listening

Encouraging clients to talk through verbal and nonverbal techniques is supportive and serves to further the relationship.

The nurse observes a client pacing in the hall. Which statement by the nurse may help the client recognize his anxiety? A. “I guess you’re worried about something, aren’t you? B. “Can I get you some medication to help calm you?” C. “Have you been pacing for a long time?” D. “I notice that you’re pacing. How are you feeling?”

The answer here is D. By acknowledging the observed behavior and asking the client to express his feelings. The nurse can best assist the client in becoming aware of his anxiety. In option A, the nurse is offering an interpretation that may or may not be accurate; the nurse also asks a question that may be answered by a “yes” or “no” response, which is not therapeutic. In option B, the nurse is intervening before accurately assessing the problem. Option C, which also encourages a “yes” or “no” response, avoids focusing on the client’s anxiety, which is the reason for his pacing.

4. Responses that indicate acceptance of the client

Accept the client whatever or how he is regardless of his condition and verbalizations. Additionally, you would not want to reject the client even if you could not condone or accept his behavior.

A male client tells the nurse he was involved in a car accident while he was intoxicated. What would be the most therapeutic response from nurse Julia? A. “Why didn’t you get someone else to drive you?” B. “Tell me how you feel about the accident.” C. “You should know better than to drink and drive.” D. “I recommend that you attend an Alcoholics Anonymous meeting.”

Choosing option A would make the client feel defensive and intimidated. Option C is judgemental. Remember, any judgemental approach is not therapeutic. Option D is about giving advice, and here, the nurse suggests that the client isn’t capable of making decisions, thus fostering dependency. For this question, option B is the correct answer as it encourages the widest range of client responses and makes the client be an active participant in the conversation.

5. Responses that pick up or relate to the client’s cues

Responding to an important cue is an essential therapeutic communication technique if the nurse focuses on the client and maintains a goal-focused interaction.

A newly admitted client diagnosed with obsessive-compulsive disorder (OCD) washes hands continually. This behavior prevents unit activity attendance. Which nursing statement best addresses this situation? A. “Everyone diagnosed with OCD needs to control their ritualistic behaviors.” B. “It is important for you to discontinue these ritualistic behaviors.” C. “Why are you asking for help if you won’t participate in unit therapy?” D. “Let’s figure out a way for you to attend unit activities and still wash your hands.”

The most appropriate statement by the nurse is, “Let’s figure out a way for you to attend unit activities and still wash your hands.” This statement reflects the therapeutic communication technique of formulating a plan of action. The nurse attempts to work with the client to develop a plan without damaging the therapeutic relationship or increasing anxiety.

Recommended Resources

Recommended books and resources for your NCLEX success:

Disclosure: Included below are affiliate links from Amazon at no additional cost from you. We may earn a small commission from your purchase. For more information, check out our privacy policy .

Saunders Comprehensive Review for the NCLEX-RN Saunders Comprehensive Review for the NCLEX-RN Examination is often referred to as the best nursing exam review book ever. More than 5,700 practice questions are available in the text. Detailed test-taking strategies are provided for each question, with hints for analyzing and uncovering the correct answer option.

Strategies for Student Success on the Next Generation NCLEX® (NGN) Test Items Next Generation NCLEX®-style practice questions of all types are illustrated through stand-alone case studies and unfolding case studies. NCSBN Clinical Judgment Measurement Model (NCJMM) is included throughout with case scenarios that integrate the six clinical judgment cognitive skills.

Saunders Q & A Review for the NCLEX-RN® Examination This edition contains over 6,000 practice questions with each question containing a test-taking strategy and justifications for correct and incorrect answers to enhance review. Questions are organized according to the most recent NCLEX-RN test blueprint Client Needs and Integrated Processes. Questions are written at higher cognitive levels (applying, analyzing, synthesizing, evaluating, and creating) than those on the test itself.

NCLEX-RN Prep Plus by Kaplan The NCLEX-RN Prep Plus from Kaplan employs expert critical thinking techniques and targeted sample questions. This edition identifies seven types of NGN questions and explains in detail how to approach and answer each type. In addition, it provides 10 critical thinking pathways for analyzing exam questions.

Illustrated Study Guide for the NCLEX-RN® Exam The 10th edition of the Illustrated Study Guide for the NCLEX-RN Exam, 10th Edition. This study guide gives you a robust, visual, less-intimidating way to remember key facts. 2,500 review questions are now included on the Evolve companion website. 25 additional illustrations and mnemonics make the book more appealing than ever.

NCLEX RN Examination Prep Flashcards (2023 Edition) NCLEX RN Exam Review FlashCards Study Guide with Practice Test Questions [Full-Color Cards] from Test Prep Books. These flashcards are ready for use, allowing you to begin studying immediately. Each flash card is color-coded for easy subject identification.

Sources and References

The following are the sources and references used for this article. Including some articles and journals we find interesting:

Abdolrahimi, M., Ghiyasvandian, S., Zakerimoghadam, M., & Ebadi, A. (2017). Therapeutic communication in nursing students: A Walker & Avant concept analysis . Electronic physician , 9 (8), 4968.
Berman, A., Snyder, S. J., Kozier, B., Erb, G. L., Levett-Jones, T., Dwyer, T., … & Parker, B. (2014). Kozier & Erb’s Fundamentals of Nursing Australian Edition (Vol. 3). Pearson Higher Education AU.
Keltner, N. L. (2013). Psychiatric nursing . Elsevier Health Sciences.
Kozier, B. (2008). Kozier and Erb’s Fundamentals of Nursing: Concepts, Process, and Practice, 8/e (With DVD) . Pearson Education India.
Rosenberg, S., & Gallo-Silver, L. (2011). Therapeutic communication skills and student nurses in the clinical setting . Teaching and learning in nursing , 6 (1), 2-8.
Ruesch, J. (1961). Therapeutic communication .
Sleeper, J. A., & Thompson, C. (2008). The use of hi-fidelity simulation to enhance nursing students’ therapeutic communication skills . International Journal of Nursing Education Scholarship , 5 (1), 1-12.
Stuart, G. W. (2014). Principles and practice of psychiatric nursing-e-book . Elsevier Health Sciences.
Wachtel, P. L. (1993). Therapeutic communication: Principles and effective practice . Guilford Press.
Wachtel, P. L. (2011). Therapeutic communication: Knowing what to say when . Guilford Press.
Webster, D. (2014). Using standardized patients to teach therapeutic communication in psychiatric nursing . Clinical simulation in nursing , 10 (2), e81-e86.
Weber, K., & Farrell, T. (2016). Developing therapeutic communication skills: Integration of standardized client simulation in an associate degree nursing program .
Videbeck, S. L. (2010). Psychiatric- mental health nursing . Lippincott Williams & Wilkins.

6 thoughts on “Therapeutic Communication Techniques NCLEX Practice Quiz & Reviewer (50 Questions)”

The rationales are the most helpful.

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Hello, kindly click on the quiz link to start the practice quiz. Thank you!

Nursing Assistant [Internet].

About Open RN

Chapter 1: Communicate Professionally Within a Health Care Setting

1.1. introduction to communicate professionally within a health care setting, learning objectives.

• Interact professionally with clients, families, and coworkers

• Display appropriate verbal and nonverbal communication skills in the health care setting

• Establish therapeutic relationships with clients and their family members

• Respond to clients exhibiting disruptive behaviors

• Respond to aggressive behavior

• Establish effective working relationships with supervisors and peers

• Demonstrate effective reporting and documentation

• Assist clients to meet spiritual needs

• Adapt care and communication to meet the psychological needs of the aging client

• Demonstrate empathy for the emotional needs and mental health of diverse clients

• Apply effective coping strategies

Effective communication is a vital skill for nursing assistants. Nursing assistants communicate professionally with patients and other health care team members throughout every shift. This chapter will review the communication process, discuss strategies for adapting communication based on the needs of the client and health care team, and introduce guidelines for documentation and reporting.

1.2. THE COMMUNICATION PROCESS

Communication is a process by which information is exchanged between individuals through a common system of symbols, signs, or behavior.[ 1 ] In the health care setting, good communication is the foundation to trusting relationships that improve client outcomes. It is the gateway to providing holistic care. Holistic care addresses a client’s physical, emotional, social, and spiritual needs.[ 2 ] The communication process involves a sender, the message, and a receiver. See Figure 1.1 [ 3 ] for an illustration of the communication process.

The Communication Process

Verbal Messages

There are many aspects of the communication process that can alter the delivery and interpretation of the message. These aspects relate to the language and experience of both the sender and receiver, referred to as semantics. People typically make reference to things they are familiar with, including landmarks, popular culture, and slang. Barriers can occur even when both parties in the conversation speak the same language. For example, if you asked a person who has never used the Internet to “Google it,” they would have no idea what that means.

Nonverbal Messages

Nonverbal messages, also referred to as body language, greatly impact the conversational process. Nonverbal communication includes body language and facial expressions, tone of voice, and pace of the conversation. See Figure 1.2 [ 4 ] for an illustration of body language communicating a message. Nonverbal communication can have a tremendous impact on the communication experience and may be much more powerful than the verbal message itself. You may have previously learned that 80% of communication is nonverbal communication. The importance of nonverbal communication during conversation has been broken down further, estimating that 55% of communication is body language, 38% is tone of voice, and 7% is the actual words spoken.[ 5 ] If the sender or receiver appears disinterested or distracted, the message or interpretation may become distorted or missed.

Body Language

Health care professionals assess receivers’ preferred methods of communication and individual characteristics that might influence communication and then adapt communication to meet the receivers’ needs. For example, nursing assistants adapt verbal instructions for adult patients with cognitive disabilities. Although the information provided might be similar to that provided to a patient without disabilities, the way the information is provided is adapted based on the patient’s developmental level. A nursing assistant may ask a cognitively intact person, “What do you want for lunch?” but adapt this information for someone with impaired cognitive function by offering a choice, such as “Do you want a sandwich or soup for lunch?” This adaptation allows the cognitively impaired patient to make a choice without being confused or overwhelmed by too many options.[ 6 ] Read more about developmental levels in the “ Human Needs and Developmental Stages ” section of this chapter.

Communication Styles

In addition to using verbal and nonverbal communication, people communicate with others using one of three styles. A passive communicator puts the rights of others before their own. Passive communicators tend to be apologetic or sound tentative when they speak and often do not speak up if they feel as if they are being wronged. Aggressive communicators , on the other hand, come across as advocating for their own rights despite possibly violating the rights of others when communicating. They tend to communicate in a way that tells others their feelings don’t matter. Assertive communicators respect the rights of others while also standing up for their own ideas and rights when communicating. An assertive person is direct, but not insulting or offensive.[ 7 ]

Assertive communication refers to a way of conveying information that describes the facts and the sender’s feelings without disrespecting the receiver’s feelings. Assertive communication is different from aggressive communication because it uses “I” messages, such as “I feel…,” “I understand…,” or “Help me to understand…,” to address issues instead of using “you” messages that can cause the receiver to feel as though they are being verbally attacked. Using assertive communication is an effective way to solve problems with patients, coworkers, and health care team members. For example, instead of using aggressive communication to say to a coworker, “You always leave your patients’ rooms a mess! I dread following you on the next shift,” an assertive communicator would use “I” messages. The assertive communicator might say, “I feel frustrated spending the first part of my shift decluttering patients’ rooms. Help me understand the reasons why you don’t empty the wastebaskets and clean up the rooms by the end of your shift.”[ 8 ]

Overcoming Communication Barriers

It is important to reflect on personal factors that influence your ability to communicate with others effectively. There are many factors that can distort the message you are trying to communicate, resulting in your message not being perceived by the receiver in the way you intended. When communicating, it is important to seek feedback that your message is clearly understood.[ 9 ] Nursing assistants must be aware of these potential barriers and try to reduce their impact by continually seeking feedback and checking understanding. Review common communication barriers in the following box.

Common Barriers to Communication in Health Care [ 10 ]

Jargon: Avoid using medical terminology, complicated wording, or unfamiliar words. When communicating with patients, explain information in common language that is easy to understand. Consider any generational, geographical, or background information that may change the perception or understanding of your message.
Lack of attention: It is easy to become task-centered rather than person-centered when caring for multiple residents. When entering a patient’s room, remember to use preprocedural steps and mindfully focus on the person in front of you to give them your full attention. Patients should feel as if they are the center of your attention when you are with them, no matter how many other things you have going on.
Noise and other distractions: Health care environments can be very noisy with people talking in the room or hallway, the TV blaring, alarms beeping, and pages occurring overhead. Create a calm, quiet environment when communicating with patients by closing doors to the hallway, reducing the volume of the TV, or moving to a quieter area, if possible.
Light: A room that is too dark or too light can create communication barriers. Ensure the lighting is appropriate according to the patient’s preference.
Hearing and speech problems: If your patient has hearing or speech problems, implement strategies to enhance communication, including assistive devices such as eyeglasses, hearing aids, and any communication aids such as whiteboards, photobooks, or microphones.
Language differences: If English is not your patient’s primary language, it is important to seek a medical interpreter and provide written handouts in the patient’s preferred language when possible. Most agencies have access to an interpreter service available by phone if they are not available on-site.
Differences in cultural beliefs: The norms of social interaction vary greatly in different cultures, as well as the ways that emotions are expressed. For example, the concept of personal space varies among people from different cultural backgrounds. Some people prefer to stand very close to one another when speaking whereas others prefer a distance of a few feet. Additionally, some patients are stoic about pain whereas others are more verbally expressive when in pain.
Psychological barriers: Psychological states of the sender and the receiver affect how the message is sent, received, and perceived. Consider what the receiver may be experiencing in the health care setting and what may change your delivery of your message. Being rushed, distracted, and overwhelmed are just a few things that can affect your message and its understanding.
Physiological barriers: It is important to be aware of patients’ potential physiological barriers when communicating. For example, if a patient is in pain, they are less likely to hear and remember what was said. If the patient is receiving pain medication, be aware these medications may alter their comprehension and response.
Physical barriers for nonverbal communication: Providing information via email or text is often less effective than face-to-face communication. The inability to view the nonverbal communication associated with a message, such as tone of voice, facial expressions, and general body language, often causes misinterpretation of the message by the receiver. When possible, it is best to deliver important information to others using face-to-face communication so that nonverbal communication is included with the message.
Differences in perceptions and viewpoints: Everyone has their own beliefs and perspectives and wants to feel “heard.” When patients feel their beliefs or perspectives are not valued, they often become disengaged from the conversation or their plan of care. Information should be provided in a nonjudgmental manner, even if the patient’s perspectives, viewpoints, and beliefs are different from your own.

1.3. COMMUNICATION WITHIN THE HEALTH CARE TEAM

Communicating with staff.

The resident is at the center of the health care team. As a nursing assistant, most of your duties will involve interaction regarding nursing services among other CNAs, LPNs, and RNs. It is important to establish a good relationship with coworkers to ensure quality resident care. Improper communication can affect the team’s ability to provide holistic care. The health care team will be discussed further in Chapter 2 .

Good communication starts by respecting those you work with and using the communication skills previously discussed to grow a trusting relationship. Knowing and fulfilling your duties, documenting and reporting the completion of these duties, and functioning in a consistent and dependable manner are keys to creating strong, professional relationships within your team.

These expectations for good communication may seem challenging as an inexperienced nursing assistant, but they can be achieved by organizing your responsibilities and managing your time. This begins by arriving on time for your shift, being dressed appropriately, being prepared to start working when your shift starts, and reviewing your assigned residents’ plans of care at the beginning of the shift. Items to review in the plan of care include the following:

Resident’s name and location
Activity level and transfer status
Assistance required for activities of daily living (ADLs)
Diet and fluid orders (see Chapter 6 for more information)
Elimination needs

Transfer status refers to the assistance the patient requires to be moved from one location to another, such as from the bed to a chair. Activities of daily living (ADLs) are daily basic tasks that are fundamental to everyday functioning (e.g., hygiene, elimination, dressing, eating, ambulating/moving). Diet and fluid orders refer to what the resident is permitted to eat and drink. Elimination needs refer to assistance the resident requires for urinating and passing stool. For example, a resident requires assistance to the toilet and uses incontinence pads.

After reviewing the cares you will be providing to your assigned patients during your shift, discuss a timeline with your coworkers that meets residents’ schedules and allows for the coordination of cares that require more than one caregiver. For example, one resident may require a two-person assist when transferring from the bed to the chair. Schedules for activities, treatments, labs, appointments, or other services should also be reviewed so that cares can be organized around these schedules.

As resident cares are completed, they must be documented in a timely manner and reported to nursing staff. Prepare a concise report to share with the nurse for each of your assigned clients. The report should include the time cares were provided and any observations or changes noted in the resident. Read more about documentation and reporting in the “ Documenting and Reporting ” section at the end of this chapter.

Communicating With the Client, Families, and Loved Ones

Therapeutic communication is a type of professional communication used with patients. It is defined as the purposeful, interpersonal, information-transmitting process through words and behaviors based on both parties’ knowledge, attitudes, and skills that leads to patient understanding and participation.[ 1 ] Therapeutic communication techniques have been used by nurses since Florence Nightingale, who insisted on the importance of building trusting relationships with patients. She believed in the therapeutic healing that results from nurses’ presence with patients.[ 2 ] Since then, several professional nursing associations have highlighted therapeutic communication as one of the most vital elements in nursing.[ 3 ] Nursing assistants also implement therapeutic communication with patients. Read an example of a nursing student effectively using therapeutic communication with patients in the following box.

Attending Behaviors

An Example of Nursing Student Using Therapeutic Communication [ 4 ],[ 5 ]

There are several components included in therapeutic communication. The health care professional uses active listening and attending behaviors to demonstrate they are interested in understanding what the patient is saying. Touch is used to professionally communicate caring, and specific therapeutic techniques are used to encourage the patient to share their thoughts, concerns, and feelings.

Active Listening and Attending Behaviors

Listening is obviously an important part of communication. A well-known phrase from a Greek philosopher named Epictetus is, “We have two ears and one mouth so we can listen twice as much as we speak.” It is important to actively listen to patients and not use competitive or passive listening. Competitive listening occurs when we are primarily focused on sharing our own point of view instead of listening to someone else. Passive listening occurs when we are not interested in listening to the other person or we assume we correctly understand what the person is communicating without verifying their message. During active listening , we communicate verbally and nonverbally that we are interested in what the other person is saying and also verify our understanding with the speaker. For example, an active listening technique is to restate what the person said and verify our understanding is correct, such as, “I hear you saying you are hesitant to go to physical therapy because you are afraid of falling. Is that correct?” This feedback process is the main difference between passive listening and active listening.[ 6 ]

Touch is a powerful way to professionally communicate caring and compassion if done respectfully while being aware of the patient’s cultural beliefs. NAs commonly use professional touch when assessing, expressing concern, or comforting patients. For example, simply holding a patient’s hand during a painful procedure can be very effective in providing comfort. See Figure 1.4 [ 7 ] for an image of a nurse using touch as a therapeutic technique when caring for a patient.

Using Touch as a Therapeutic Technique

Therapeutic Communication Techniques

Therapeutic communication techniques are specific methods used to provide patients with support and information while focusing on their concerns. Nursing assistants help patients complete activities of daily living and meet goals in their plan of care based on their needs, values, skills, and abilities. It is important to recognize the autonomy of the patient to make their own decisions, maintain a nonjudgmental attitude, and avoid interrupting. Depending on the developmental stage and educational needs of the patient, appropriate terminology should be used to promote patient understanding and rapport. When using therapeutic communication, health care professionals often ask open-ended questions, repeat information, or use silence to prompt patients to process their concerns. Table 1.3a describes a variety of therapeutic communication techniques.

Therapeutic Communication Techniques[ 8 ]

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In addition to the therapeutic techniques listed in Table 1.3a , health care professionals should genuinely communicate with patients with empathy. Communicating honestly, genuinely, and authentically is powerful. It opens the door to establishing true connections with others.[ 9 ] Communicating with empathy can be described as providing “unconditional positive regard.” Research has demonstrated that when health care professionals communicate with empathy, there is improved patient healing, reduced symptoms of depression, and decreased medical errors.[ 10 ]

Nontherapeutic Responses

Health care professionals must be aware of potential barriers to communication. In addition to the common communication barriers discussed in the “ Communication Styles ” subsection of this chapter, there are several nontherapeutic responses to avoid. These nontherapeutic responses often block the patient’s communication of their feelings or ideas. See Table 1.3b for a description of nontherapeutic responses.[ 11 ]

Nontherapeutic Responses[ 12 ]

Strategies for Effective Communication

In addition to overcoming common communication barriers, using active listening and therapeutic communication techniques, and avoiding nontherapeutic responses, there are additional strategies for promoting effective communication when providing patient-centered care. Specific questions to ask patients are as follows[ 13 ]:

What concerns do you have about your plan of care?
What questions do you have about your daily routine?
Did I answer your question(s) clearly, or is there additional information you would like?

Read the care plan carefully and access any social history available. If family members or friends visit and it seems appropriate, talk with them about the client without intruding or taking up a lot of their time together. This information helps you build trust and care for the client based on their preferences and life history. For example, you might learn the resident lived on a farm most of their life and enjoyed taking care of their horses. Striking up conversations about horses is a way to build rapport with this client.
Review any changes in routine or in the plan of care for assisting with ADLs with the client to improve understanding and participation.
If there are questions you can’t answer, be sure to report to the nurse so someone can follow up with the client. Check back with the client to ensure they have had their questions answered.
Observe nonverbal communication from clients. Do they seem to interact during care, or is it something that they are merely tolerating and just trying to get through each day? Find an approach so they are comfortable with receiving care.

Adapting Your Communication

When communicating with patients, their family members, and other caregivers, note your audience and adapt your message based on characteristics such as age, developmental level, cognitive abilities, and any communication disorders. For patients with language differences, it is vital to provide trained medical interpreters when important information is communicated.

Adapting communication according to an individual’s age and developmental level includes the following strategies[ 14 ]:

When communicating with children, speak calmly and gently. It is often helpful to demonstrate what will be done during a procedure on a doll or stuffed animal. To establish trust, try using play or drawing pictures.
When communicating with adolescents, give freedom to make choices within established limits.
When communicating with older adults, be aware of potential vision and hearing impairments that commonly occur and address these barriers accordingly. For example, if a patient has glasses and/or hearing aids, be sure these devices are in place before communicating.

Strategies for Communicating With Patients With Impaired Hearing, Vision, and Speech

In addition to adapting your communication to your audience, there are additional strategies to use with individuals who have impaired hearing, vision, or speech.

Impaired Hearing [ 15 ]

Gain the person’s attention before speaking (e.g., through touch)
Minimize background noise
Position yourself 2-3 feet away from the patient
Facilitate lip-reading by facing the person directly in a well-lit environment
Use gestures, when necessary
Listen attentively, allowing the person adequate time to process communication and respond
Refrain from shouting at the person
Ask the person to suggest strategies for improved communication (e.g., speaking toward a better ear, moving to well-lit area, and speaking in a lower-pitched tone)
Face the person directly, establish eye contact, and avoid turning away mid-sentence
Simplify language (e.g., do not use slang but do use short, simple sentences), as appropriate
Read the care plan for information on the preferred method of communicating (whiteboards, pictures, etc.)
Assist the person using any devices such as hearing aids or voice amplifiers
Report any changes to the nurse

Impaired Vision [ 16 ]

Identify yourself when entering the person’s space
Ensure the patient’s eyeglasses are cleaned and stored properly when not in use, and assist the patient in wearing them during waking hours
Provide adequate room lighting
Minimize glare (e.g., offer sunglasses, draw window covering, position with face away from window)
Provide educational materials in large print as available
Read pertinent information to the patient
Provide magnifying devices

Impaired Speech [ 17 ]

Some patients may have problems processing what they are hearing or in responding to questions due to dementia, brain injuries, or prior strokes. This difficulty is referred to as aphasia . There are different types of aphasia. People with expressive aphasia understand speech and know what they want to say, but frequently speak in short phrases that are produced with great effort. For example, they may intend to say, “I would like to go to the bathroom,” but instead the words, “Bathroom, Go,” are expressed. People with receptive aphasia often speak in long sentences, but what they say may not make sense. They are unable to understand both verbal and written language. Aphasia often causes the person to become frustrated when they cannot communicate their needs. Review the following evidence-based strategies to enhance communication with a person with impaired speech[ 18 ]:

Modify the environment to minimize excess noise and decrease emotional distress
Phrase questions so the patient can answer using a simple “Yes” or “No,” being aware that patients with expressive aphasia may provide automatic responses that are incorrect
Monitor the patient for frustration, anger, depression, or other responses to impaired speech capabilities
Provide alternative methods of speech communication (e.g., writing tablet, flash cards, eye blinking, communication board with pictures and letters, hand signals or gestures, or computer)
Adjust your communication style to meet the needs of the patient (e.g., stand in front of the patient while speaking, listen attentively, present one idea or thought at a time, speak slowly but avoid shouting, use written communication, or solicit the family’s assistance in understanding the patient’s speech)
Ensure the call light is within reach
Repeat what the client said to ensure accuracy
Instruct the client to speak slowly
Read the care plan for instructions from the speech therapist

Responding to Challenging Situations

Being a care provider is a very rewarding career, but it also includes dealing with challenging situations. Using strong communication techniques can de-escalate situations and put patients, loved ones, and staff at ease. It is impossible to predict what behavior you may encounter as a health care worker, but having a solid basis of communication techniques can prepare you to better handle unique situations.

Memory Impairment and Behavioral Health Issues

As a nursing assistant, you will likely encounter older adults with varying degrees of memory impairment. Older adults are defined as adults aged 65 years old or older.[ 19 ] Residents with memory issues often become confused and can feel overwhelmed by everyday situations. For those with impaired cognitive functioning like dementia, it may not be possible to reorient them to the current time and place or to move them on from thoughts that are not based in the current situation. Aphasia and confusion can cause frustration that can result in agitation or aggression. Agitation refers to behaviors that fall along a continuum ranging from verbal threats and motor restlessness to harmful aggressive and destructive behaviors. Mild agitation includes symptoms such as irritability, oppositional behavior, inappropriate language, and pacing. Severely agitated patients are at immediate risk of harming themselves or others through assaultive or self-injurious behavior, and they are capable of causing property damage.[ 20 ] Aggression is an act of attacking without provocation.[ 21 ] Agitation and aggression will be discussed in more detail in Chapter 10 , but general guidelines to prevent aggression and agitation include the following:

Keep the environment calm and as quiet as possible.
Build trusting relationships by learning resident preferences and routines.
Gather information from family members and loved ones about the patient’s background and beliefs.
Offer choices to allow the patient to communicate preferences, but do not cause them to be overwhelmed with too many decisions.
Stick to a daily routine for ADLs, meals, and activities.
Empathize with the resident and understand that challenging behavior is often communication of emotion due to cognitive impairment and not a choice.
Practice validation therapy. Validation therapy is a method of therapeutic communication used to connect with someone who has moderate- to late-stage dementia and avoid agitation. It places more emphasis on the emotional aspect of a conversation and less on the factual content, thereby imparting respect to the person, their feelings, and their beliefs. Validation may require you to agree with a statement that has been made, even though the statement is neither true or real, because to the person with dementia, it feels both true and real.[ 22 ] For example, if the resident with dementia believes they are waiting to catch the bus and is intent on doing so, sit with them by the window as if you are waiting for a bus and continue to have interaction with them until they are no longer concerned with the bus.
Redirect behavior if appropriate. For example, suggest alternative activities such as walking around the facility, looking at photos, listening to music, or other activities the resident enjoys.
Focus on safety for residents experiencing delusions or hallucinations. Delusions are unshakable beliefs in something that isn’t true or based on reality. For example, a resident may refuse to eat breakfast because they have a delusion that staff are trying to poison them. Hallucinations are sensing things such as visions, sounds, or smells that seem real but are not. For example, a resident may refuse to enter a room because they have hallucinations of big spiders crawling on the walls. If a patient is having delusions or hallucinations, never contradict them or tell them what they perceive isn’t real. Instead, empathize with them and do whatever is possible to help them feel safe. For example, offer to move to another area or investigate what the resident is concerned about.

Dealing With Stress

The stress response is a common psychological barrier to effective communication. It can affect the message sent by the sender or the reception by the receiver. The stress response is a common reaction to life events, such as a health care worker feeling overwhelmed with tasks to complete for multiple patients or a patient feeling stressed when admitted to a hospital or receiving a new diagnosis. Symptoms of the stress response include irritability, sweaty palms, a racing heart, difficulty concentrating, and impaired sleep. It is important to recognize symptoms of the stress response in ourselves and our patients and use strategies to manage the stress response when communicating.

There are several stress management strategies to use to manage the stress response[ 23 ]:

Use relaxation breathing to become aware of one’s breathing. This technique includes taking deep breaths in through the nose and blowing it out through the mouth. This process is repeated at least three times in succession and then as often as needed throughout the day.
Make healthy diet choices. Avoid caffeine, nicotine, and junk food because these items can increase feelings of anxiety or being on edge.
Make time for exercise. Exercise stimulates the release of natural endorphins that reduce the body’s stress response and also helps to improve sleep.
Get enough sleep. Set aside at least 30 minutes before going to bed to wind down from the busyness of the day. Avoid using electronic devices like cell phones before bedtime because the backlight can affect sleep.
Start by lying down somewhere comfortable and firm, like a rug or mat on the floor. Get yourself comfortable.
Relax and try to let your mind go blank. Breathe slowly, deeply, and comfortably, while gradually and consciously relaxing all your muscles, one by one.
Work around the body one main muscle area at a time, breathing deeply, calmly, and evenly. For each muscle group, clench the muscles tightly and hold for a few seconds, and then relax them completely. Repeat the process, noticing how it feels. Do this for each of your feet, calves, thighs, buttocks, stomach, arms, hands, shoulders, and face.

Managing Clients’ and Family Members’ Stress

Being cared for by strangers can feel very challenging to clients. Residents in long-term care settings have frequently experienced major physical and/or cognitive changes that caused a loss of their independence and sometimes some of their autonomy. Autonomy is each individual’s right to self-determination and decision-making based on their unique values, beliefs, and preferences. It is important for the nursing assistant to empathize with these losses and the new reality that residents must become accustomed to when moving into a long-term care facility. Reflect on the exercise in the following box to understand a resident’s feelings during their transition:

Reflection Activity

When you wake up in the morning, imagine that you cannot get out of bed on your own. Think about putting on your call light as you need to use the restroom and having to wait until someone is available to help. As you look around the room, you see some of your belongings, but many are no longer there. The floor is clean but bare; your recliner is nearby but you can’t move into it. You wish you could go to the kitchen to have coffee with your partner, but they are no longer around. You miss your pet that used to sleep with you each night. Finally, an aide arrives, and although they are friendly, it is another new face that will help you to the bathroom and with other care needs.

Clients usually become more comfortable with their new reality as they become familiar with a new routine and their new home. It is important to remember that emotions related to loneliness, feeling like a burden, and loss of independence can arise at any time. The nursing assistant can help residents adjust to their new environment in the following ways:

Greet clients by their preferred name and introduce yourself.
Ask clients their preferences for their care. Always communicate what you will be doing next and allow the resident to redirect or refuse care.
Provide privacy when assisting with cares.
Use confidentiality when documenting information or reporting to other members of the health care team.
Treat belongings carefully and with respect and remember the client’s room is their home.
Listen to the resident and address concerns if they arise. If you cannot adequately address the resident’s concerns, communicate these concerns to the nurse or supervisor.

Family members and other loved ones may have questions and concerns about the resident’s care. Read more information about managing their concerns in the following “Dealing With Conflict” section.

Dealing With Conflict

Health care professionals provide personal care at integral times in the lives of patients. The demands of caregiving and the associated rapid decision-making process can create stress for health care team members, patients, family members, and other loved ones. Managing care and making decisions can cause conflict among all involved. As a nursing assistant, it is important to be aware of your role and responsibility when managing conflict.

When a patient does not want to participate in care necessary to support their proper hygiene or health maintenance, the nursing assistant can use effective communication to encourage actions and promote desired outcomes. When a resident declines care, here are some actions the nursing assistant may use that respect their choices but allow care standards to be met:

Re-approach the resident at a later time.
Offer an alternative method. For example, a resident may not want to shower or take a bath but would be willing to have a full bed bath, allowing them to stay covered and warm throughout care.
Remind the resident what may occur if care is not provided, such as higher risk of infection, open areas in the skin, odor, etc.
Encourage as much control and independence as possible. Allow the resident to direct the process if able and offer as many choices as are appropriate.

Family members and other supports may have concerns about the plan of care for a resident. This may be due to lack of medical knowledge, little experience with the procedures of health care facilities, or a feeling of helplessness in regard to their loved one’s situation. The nursing assistant should listen to and acknowledge these concerns. Following confidentiality guidelines, interventions included in the plan of care can be discussed if the resident has permitted disclosure of this information. However, the nursing assistant should only disclose information when they have confirmed the resident has permitted disclosure. It may be beneficial for family members or others involved to discuss concerns with the nurse or unit supervisor and possibly schedule a care conference with the health care team to resolve their concerns. In this instance, the aide should understand that any anger directed at them may be a result of the situation rather than a reflection of anything they have personally done.

Conflicts among coworkers can also be addressed with assertive communication techniques. As discussed in the “Communication Styles” subsection, using assertive communication is the best approach to address workplace conflict and a respectful way to make one’s viewpoints known. Communication should start between the two parties that have the conflict before involving other staff. It is best to think about the situation and develop a potential solution before approaching the coworker. Frame the situation from your perspective using “I” messages. If the situation is especially tense, it may be beneficial to allow some time between the experience and the discussion to reduce stress and think more logically about the conflict. A typical time frame is to wait one day to think logically about a conflict before addressing it, often referred to as the “24-hour Rule.” If you have discussed your concerns with the coworker and offered a potential solution without any resolution in the situation, it is appropriate to notify your supervisor for additional assistance at that time. See an example of conflict resolution in the following box.

Example of Conflict Resolution

A nursing assistant becomes frustrated with a coworker who works on the previous shift when they continue to neglect to empty the wastebaskets and tidy up the residents’ rooms before the end of their shift. When it became apparent this was a pattern of behavior and not an isolated incident due to an exceedingly busy shift, the nursing assistant approached the coworker and said, “I feel frustrated when I start my shift with full wastebaskets and untidy rooms for the residents you care for. Can you help me understand why these things aren’t accomplished by the end of your shift? It works for me to clean up the room when I am finished assisting the resident. That way I don’t forget to come back, and the residents seem to appreciate it as well.” The coworker apologized for this oversight and committed to completing these tasks before leaving at the end of their shift.

1.4. HUMAN NEEDS AND DEVELOPMENTAL STAGES

It is important to understand human needs and developmental stages to communicate effectively and provide holistic care.

Maslow’s Hierarchy of Needs

Maslow’s Hierarchy of Needs was created in 1943 by American psychologist Abraham Maslow. Maslow’s theory is based on the ranking of the importance of human needs and the belief that human actions are based on motivation to meet these needs. See an illustration of Maslow’s Hierarchy of Needs in Figure 1.5 .[ 1 ]

Maslow’s theory states that unless the basic needs in the lower levels of the hierarchy are met, humans cannot experience the higher levels of psychological and self-fulfillment needs. The levels of Maslow’s Hierarchy of Needs have the following definitions[ 2 ]:

Physiological needs: This is the most important level with basic needs humans must have to stay alive and function, including air, food, drink, shelter, clothing, warmth, sex, and sleep.

Safety needs: People want to experience order, predictability, and control in their lives. This includes emotional security, freedom from fear, and health and well-being (such as safety against falls and injury). For new residents in a long-term care facility, this level includes becoming comfortable in familiar surroundings as opposed to feeling apprehension when experiencing a new environment.

Love and belongingness: After physiological and safety needs have been fulfilled, the third level of human needs is social and involves feelings of belongingness. Belongingness refers to a human emotional need for interpersonal relationships, connectedness, and being part of a group. A group may mean biological families, friends, or other supporters. It may also include physical intimacy and romantic relationships.

Esteem needs: Esteem needs include self-worth and feelings of accomplishment and respect. It includes how one views oneself and the feeling of contributing to something of importance.

Self-actualization: Self-actualization is the highest level and refers to the realization of a person’s potential and self-fulfillment. This level refers to the desire to attain life goals and being truly satisfied in being the most one can be.

Maslow theorized that one cannot attain a higher level in any of these categories if the levels below are not met. For example, one is not motivated by a sense of belonging if they are focused on obtaining basic needs such as food, water, and shelter. The hierarchy is subjective because each individual determines what each level means for them. For instance, for one person, safety may mean living in the neighborhood where they grew up, whereas for another individual it means having a daily routine. Belongingness to one person may mean being a part of a community group whereas to another it may mean having one very close friend. Self-esteem and feelings of accomplishment may be defined by one person as successfully graduating from high school, whereas to another it is defined by being able to run a mile without stopping. Self-actualization is defined by each individual and can mean things such as being a good parent, graduating from college, or achieving one’s dream of becoming a nurse.

The levels of belongingness and self-actualization also include a person’s spirituality and how they find meaning and purpose in life. Spirituality is often mistakenly equated with religion, but spirituality is a broader concept that includes how people seek meaning and purpose in life, as well as establish relationships with family, their community, nature, and/or a higher power.[ 3 ]

Maslow’s Hierarchy of Needs is a good basis for providing holistic care and communicating with clients based on their needs and preferences. For example, in nursing, priorities of care are based on physiological needs and safety. Additionally, knowing that a newly admitted resident may have difficulty reaching a higher level of needs if their basic needs are not met is a good starting point for providing care.

Strategies that integrate Maslow’s Hierarchy of Needs when providing care to residents include the following:

Following the nursing plan of care to meet physiological needs.
Implementing fall precautions to keep residents safe.
Answering call lights promptly and consistently providing a calm, comfortable environment to make residents feel secure.
Respecting residents’ belongings and asking their preferences for grooming, bathing, and meals to satisfy self-esteem needs.
Encouraging interaction among residents with similar interests to promote a feeling of belongingness.
Offering to bring residents to on-site religious activities or referring them to social services for a chaplain visit to promote self-actualization and a feeling of belongingness.

Maslow’s Hierarchy of Needs can also be applied to the work environment to enhance professionalism by doing the following:

Offering assistance to coworkers when able to promote a feeling of security and belongingness and also maintaining residents’ physiological needs and safety as a team.
Participating fully in the reporting and documentation process of the facility to meet residents’ physiological and safety needs.
Accurately following training and agency policies and procedures to encourage feelings of self-esteem in the health care worker.
Being accountable for one’s actions and job responsibilities to promote a feeling of self-actualization by meeting one’s potential.

Erikson’s Stages of Development

Another psychologist named Erik Erikson created a theory of psychosocial development that also describes how one’s personality is developed. It theorizes there are eight stages of development based on a person’s chronological age. Development occurs based on the main conflict or challenge confronted during that period of time. Each stage can create either a virtue/strength or a maladaptive tendency. Erikson proposed that those who have a stronger sense of identity from resolving these conflicts over time have fewer conflicts within themselves and with others and, subsequently, a decreased level of anxiety.[ 4 ]

Erikson’s stages of development are defined as trust versus mistrust, autonomy versus shame, initiative versus guilt, industry versus inferiority, identity versus identity confusion, intimacy versus isolation, generativity versus stagnation, and integrity versus despair[ 5 ]:

Trust vs. Mistrust

The first stage establishes trust (or mistrust) that basic needs, such as nourishment and affection, will be met. Trust is the basis of our development during infancy (birth to 12 months). Infants are dependent on their caregivers, so caregivers who are responsive and sensitive to their infant’s needs help their baby to develop a sense of trust; their baby will see the world as a safe, predictable place. Unresponsive caregivers who do not meet their baby’s needs can engender feelings of anxiety, fear, and mistrust; their baby may see the world as unpredictable.[ 6 ]

Autonomy vs. Shame

Toddlers begin to explore their world and learn that they can control their actions and act on the environment to get results. They begin to show clear preferences for certain elements of the environment, such as food, toys, and clothing. A toddler’s main task is to resolve the issue of autonomy versus shame and doubt by working to establish independence. For example, we might observe a budding sense of autonomy in a two-year-old child who wants to choose her clothes and dress herself. Although her outfits might not be appropriate for the situation, her input in such basic decisions has an effect on her sense of independence. If denied the opportunity to act on her environment, she may begin to doubt her abilities, which could lead to low self-esteem and feelings of shame.[ 7 ]

Initiative vs. Guilt

Once children reach the preschool stage (ages 3–6 years), they are capable of initiating activities and asserting control over their world through social interactions and play. By learning to plan and achieve goals while interacting with others, preschool children can master this task. Those who do will develop self-confidence and feel a sense of purpose. Those who are unsuccessful at this stage may develop feelings of guilt.[ 8 ]

Industry vs. Inferiority

During the elementary school stage (ages 7–11), children begin to compare themselves to their peers to see how they measure up. They either develop a sense of pride and accomplishment in their schoolwork, sports, social activities, and family life, or they feel inferior and inadequate when they don’t measure up.[ 9 ]

Identity vs. Identity Confusion

In adolescence (ages 12–18), children develop a sense of self. Adolescents struggle with questions such as “Who am I?” and “What do I want to do with my life?” Along the way, most adolescents try on many different selves to see which ones fit. Adolescents who are successful at this stage have a strong sense of identity and are able to remain true to their beliefs and values in the face of problems and other people’s perspectives. Teens who do not make a conscious search for identity or those who are pressured to conform to their parents’ ideas for the future may have a weak sense of self and experience role confusion as they are unsure of their identity and confused about the future.[ 10 ]

Intimacy vs. Isolation

People in early adulthood (i.e., 20s through early 40s) are ready to share their lives with others after they have developed a sense of self. Adults who do not develop a positive self-concept in adolescence may experience feelings of loneliness and emotional isolation.[ 11 ]

Generativity vs. Stagnation

When people reach their 40s, they enter a time period known as middle adulthood that extends to the mid-60s. The social task of middle adulthood is generativity versus stagnation. Generativity involves finding your life’s work and contributing to the development of others, through activities such as volunteering, mentoring, and raising children. Those who do not master this task may experience stagnation, having little connection with others and little interest in productivity and self-improvement.[ 12 ]

Integrity vs. Despair

The mid-60s to the end of life is a period of development known as late adulthood. People in late adulthood reflect on their lives and feel either a sense of satisfaction or a sense of failure. People who feel proud of their accomplishments feel a sense of integrity and often look back on their lives with few regrets. However, people who are not successful at this stage may feel as if their life has been wasted. They focus on what “would have,” “should have,” or “could have” been. They face the end of their lives with feelings of bitterness, depression, and despair.[ 13 ]

By combining Maslow’s and Erickson’s theories of development and motivation, we can begin to understand why some patients need more encouragement, space, or time to allow caregivers to provide assistance with their ADLs to maintain physical and emotional health.

View the following YouTube video[ 14 ] for more information about Erikson’s theory of development: Erikson’s Psychosocial Development | Individuals and Society.

Assisting With Spiritual Needs

When clients experience a serious illness or injury, they often grapple with the existential question, “Why is this happening to me?” This question can be a sign of spiritual distress defined as, “A state of suffering related to the inability to experience meaning in life through connections with self, others, the world, or a superior being.” Spiritual well-being is a pattern of experiencing meaning and purpose in life through connectedness with self, others, art, music, literature, nature, and/or a power greater than oneself. Spirituality is often mistakenly equated with religion, but spirituality is a broader concept. Elements of spirituality include faith, meaning, love, belonging, forgiveness, and connectedness.[ 15 ] Spirituality and religion can change over a person’s lifetime and vary greatly between people. Some people who are very spiritual may not belong to a specific religion.

Religion is frequently defined as an institutionalized set of beliefs and practices. Many religions have specific rules about food, religious rituals, clothing, and touching. Supporting these rules when they are meaningful part of a resident’s spirituality is an effective way to support the resident and maintain a caring, professional relationship. The nursing assistant should discuss these aspects with the nurse to assure they support the plan of care for the resident and encourage other staff members to provide support. Many nursing homes and assisted living facilities offer religious or spiritual opportunities through their Activities departments.

Many hospitals, nursing homes, assisted living facilities, and hospices employ professionally trained chaplains to assist with the spiritual, religious, and emotional needs of clients, family members, and staff. In these settings, chaplains support and encourage people of all religious faiths and cultures and customize their approach to each individual’s background, age, and medical condition. Chaplains can meet with any individual regardless of their belief, or lack of belief, in a higher power and can be very helpful in reducing anxiety and distress.[ 16 ] NAs may suggest chaplain services for their clients.

An important way to assist a client with their spiritual well-being is to ask them what they need to feel supported in their faith and then try to accommodate their requests, if possible. Explain that spiritual health helps the healing process. For example, perhaps they would like to speak to their clergy, spend some quiet time in meditation or prayer without interruption, or go to the on-site chapel. Many agencies have chaplains onsite that can be offered to patients as a spiritual resource.[ 17 ]

If the client or family member requests a nursing assistant to pray with them, it is acceptable to pray with them or find someone who will. Some nursing assistants may feel reluctant to pray with patients when they are asked for various reasons; they may feel underprepared, uncomfortable, or unsure if they are “allowed to.” Nursing assistants, nurses, and other health care team members are encouraged to pray with their patients to support their spiritual health, as long as the focus is on the patient’s preferences and beliefs, not their own preferences. Having a short, simple prayer ready that is appropriate for any faith may help a health care professional feel prepared for this situation. However, if the nursing assistant does not feel comfortable praying with the patient as requested, the nurse should be notified so the chaplain can be requested to participate in prayer with the patient.[ 18 ]

It is important to support clients within their own faith tradition, but it is not appropriate for the nursing assistant to take this opportunity to attempt to persuade a patient towards a preferred religion or belief system. The role of the nursing assistant is to respect and support the client’s values and beliefs, not promote the nursing assistant’s values and beliefs.[ 19 ]

1.5. DOCUMENTING AND REPORTING

Guidelines for documentation.

Accurate documentation and reporting are vital to proper client care. Reporting is oral communication between care providers that follows a structured format and typically occurs at the start and end of every shift or whenever there is a significant change in the resident. Documentation is a legal record of patient care completed in a paper chart or electronic health record (EHR). It is also referred to as charting. Checklists and flowcharts completed in the resident’s room may also become part of the paper chart. Documentation is used in a court of law to prove patient care was completed if a lawsuit is filed, with the rule of thumb being, “If it wasn’t documented, it wasn’t done.” Documentation is also reviewed by other health care team members to provide holistic care.

Accurate documentation should follow these guidelines:

The client’s chart is confidential and should only be shared with those directly involved in care. If using paper, cover information with a blank sheet. When using technology, be sure screens are visible only to you and log out after each use. Never share security measures like passwords or PIN with anyone else.
Document as soon as any care is completed.
Include date, time, and signature per facility policy.
Use facts, not opinions. An opinion is, “The resident doesn’t like their food.” Instead, a fact should be charted, such as, “The resident refused their meal and stated they were not hungry.”
Use measuring tools, such as a graduated cylinder or a tape measure, whenever possible to provide accurate data. If you do have to estimate, provide a comparison such as, “Drainage noted on the bandage was the size of a quarter.”
If you chart on paper, always use a black pen. If you make a mistake, draw only one line through the entry, write the word “mistaken entry,” and add your initials. Do not use correction fluid or completely black out the entry.

Long-term care facilities are required to complete additional documentation called a Minimum Data Set (MDS). The MDS is a standardized assessment tool for all residents of long-term care facilities certified to receive reimbursement by Medicare or Medicaid. The MDS is completed by a registered nurse who reviews documentation by nursing assistants to complete some parts of the MDS. Accurate documentation is vital so that facilities are appropriately reimbursed for the services provided to clients.

The MDS nurse will review the nursing assistant’s documentation pertaining to a resident’s sensory abilities, specifically their communication skills, hearing, and vision. For this reason, documentation must be accurate and thorough regarding assistive devices, the amount of assistance required, and skin observations. For example, devices for communication, such as whiteboards, photo books, charts, hearing aids, or glasses, must be appropriately documented, as well as the amount of assistance required for dressing, bathing, eating, toileting, repositioning in bed, transferring, and ambulating. Skin observations made during cares should also be thoroughly documented so they can be included in MDS reporting.

View the MDS PDF from the Centers for Medicaid and Medicare Services.

Guidelines for Reporting

Reporting client information to other nursing assistants or to a nurse for follow-up is an important part of meeting client needs and providing competent care. When providing an oral report, be mindful of confidentiality and where the report is given so no one overhears private information. Appropriate places for reporting include a closed room, a nurse’s station away from resident rooms and common areas, or in a private resident’s room with the door closed.

Throughout this textbook, specific information that should be documented and reported will be noted. Generally, a nursing assistant should report any physical changes in a client that seem unusual or behavior that is out of the ordinary for that person. Examples that require immediate notification to the nurse may include the following:

Strong odors from urine, oral care, or wounds
Reddened, warm, or open skin areas
Difficulty breathing or chest pain

Objective information includes information about a client that can be observed through the four senses of sight, touch, hearing, or smell. This information is referred to as signs . Objective information can be verified by another individual and often includes measuring tools such as a scale, thermometer, specimen cup, or graduated cylinder. An example of objective information is the client’s temperature was 98.6 degrees Fahrenheit.

Subjective information is information reported to you by clients or their family members. This information is referred to as symptoms . It is documented by using the exact wording reported with quotation marks. An example of subjective information is the resident stating, “I have a headache.”

Military Time

Military time is used to record the time care is provided and any other pertinent information for the resident. It avoids confusion between daytime and nighttime hours because it does not require a.m. or p.m. Each hour of the day has its own number from 1 to 24 and no colons are used. Beginning at 1:00 p.m., simply add 12 to the hour. For example, 1:46 p.m. is written as 1346. For morning hours up to 9:59 p.m., add a zero in front of the hour. For example, 9:24 a.m. is written as 0924. Midnight is documented as either 2400 or 0000.

When reporting in military time, morning hours are pronounced beginning with “zero” or “O.” For example, 7:00 a.m. is pronounced “zero seven hundred” or “oh seven hundred.” The time of 2:43 p.m. is pronounced “fourteen forty-three.” See Figure 1.6 [ 1 ] below for conversion from civilian to military time.

1.6. LEARNING ACTIVITIES

I. GLOSSARY

Listening while communicating verbally and nonverbally that we are interested in what the other person is saying and also verifying our understanding with the speaker.

Daily basic tasks that are fundamental to everyday functioning (e.g., hygiene, elimination, dressing, eating, ambulating/moving).

The act of attacking without provocation.

Individuals who come across as advocating for their own rights when communicating despite possibly violating the rights of others.

Behaviors that fall along a continuum ranging from verbal threats and motor restlessness to harmful aggressive and destructive behaviors.

A condition with difficulty processing what one is hearing or responding to questions due to dementia, brain injuries, or strokes.

A way of conveying information that describes the facts and the sender’s feelings without disrespecting the receiver’s feelings.

Individuals who respect the rights of others while also standing up for their own ideas and rights when communicating.

Each individual’s right to self-determination and decision-making based on their unique values, beliefs, and preferences.

A human emotional need for interpersonal relationships, connectedness, and being part of a group.

A process by which information is exchanged between individuals through a common system of symbols, signs, or behavior.

Listening that occurs when we are primarily focused on sharing our own point of view instead of listening to someone else.

Unshakable beliefs in something that isn’t true or based on reality.

Orders regarding what the resident is permitted to eat and drink.

A legal record of patient care completed in a paper chart or electronic health record (EHR).

Assistance the resident requires for urinating and passing stool.

A condition where a person senses things such as visions, sounds, or smells that seem real but are not.

Health care that addresses a patient’s physical, emotional, social, and spiritual needs.

A theory stating that unless basic human needs within a hierarchy are met, humans cannot experience higher levels of psychological and self-fulfillment needs.

A standard for recording time that avoids confusion between daytime and nighttime hours because each hour of the day is represented by a number ranging from 00:00 to 24:59.

A standardized assessment tool for all residents of long-term care facilities certified to receive reimbursement by Medicare or Medicaid.

Communication that includes body language and facial expressions, tone of voice, and pace of the conversation.

Anything that can be observed through sight, touch, hearing, or smell, referred to as “signs.” An example of objective information is the client’s temperature was 98.6 degrees Fahrenheit.

Adults aged 65 years old or older.

Individuals who put the rights of others before their own when communicating.

Listening that occurs when we are not interested in listening to the other person or we assume we correctly understand what the person is communicating without verifying their message.

Stress management techniques that focus on reducing muscle tension and using mental imagery to induce calmness.

A stress management technique focused on becoming aware of one’s breathing.

Oral communication between care providers that follows a structured format and typically occurs at the start and end of every shift.

Objective information obtained through the senses of sight, hearing, smell, or touch.

The body’s response to stress that can include irritability, sweaty palms, a racing heart, difficulty concentrating, and impaired sleep.

Information reported by clients or their family members referred to as “symptoms.” An example of subjective information is the resident stating, “I have a headache.”

Subjective information reported by clients or their family members. Symptoms are documented by using quotes around the exact words expressed by the client or their family member. For example, the client reported, “I have a headache.”

A type of professional communication used with patients defined as the purposeful, interpersonal, information-transmitting process through words and behaviors based on both parties’ knowledge, attitudes, and skills that leads to patient understanding and participation.

Assistance the patient requires to be moved from one location to another, such as from the bed to a chair.

A method of therapeutic communication used to connect with someone who has moderate to late-stage dementia and avoid agitation.

Licensed under a Creative Commons Attribution 4.0 International License. To view a copy of this license, visit https://creativecommons.org/licenses/by/4.0/ .

Cite this Page Reuter-Sandquist M; Open Resources for Nursing (Open RN); Ernstmeyer K, Christman E, editors. Nursing Assistant [Internet]. Eau Claire (WI): Chippewa Valley Technical College; 2022. Chapter 1: Communicate Professionally Within a Health Care Setting.
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INTRODUCTION TO COMMUNICATE PROFESSIONALLY WITHIN A HEALTH CARE SETTING
THE COMMUNICATION PROCESS
COMMUNICATION WITHIN THE HEALTH CARE TEAM
HUMAN NEEDS AND DEVELOPMENTAL STAGES
DOCUMENTING AND REPORTING
LEARNING ACTIVITIES

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IMAGES

EXAM 3 communication & patient education Flashcards
Patient Communication Exam 2 Flashcards
Patient Communication Flashcards
Clinical Communication Skills Flashcards
Communication/Patient Safety Flashcards
Chapter 9: Communication/Therapeutic Relationship Flashcards

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COMMENTS

Patient Communication Flashcards
defined as the sending and receiving of messages. 4 critical components of communication (4 elements) 1.Sender -speech or action. 2.Message - info being sent. 3.Receiver (decodes the message) 4. Feedback - response of the receiver. What is noise. Noise is anything that gets in the way of effective communication.
Patient communication Flashcards
Q-Chat. Created by. Kayla_Jones2908. Study with Quizlet and memorize flashcards containing terms like Communication Process, Sender, Encoding and more.
Communicating with Patients Quiz Flashcards
Study with Quizlet and memorize flashcards containing terms like Which part of patient interaction involves the health care worker describing the procedure in lay terms and explaining why it is being done and what it should accomplish? ... intro into medical practice and communication skills test. 29 terms. Kranes2017. Preview. Public Speaking ...
Strategies for effective patient communication
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2.3: Communicating with Patients
Ask the patient to suggest strategies for improved communication (e.g., speaking toward better ear and moving to well-lit area) Face the patient directly, establish eye contact, and avoid turning away mid sentence. Simplify language (i.e., do not use slang but do use short, simple sentences), as appropriate.
Patient-Centered Communication: Basic Skills
The Institute of Medicine identified patient-centered care as one of six elements of high-quality health care. 1 A patient-centered approach to care is based on three goals 1 - 3: eliciting the ...
Patient-Clinician Communication: Basic Principles and Expectations
Drawing from these principles, the basic individual and mutual expectations of both patients and their clinicians can be identified. These expectations are discussed below and summarized in the accompanying box. 1. Mutual respect. Each patient (or agent) and clinician engaged as full decision-making partners.
Patient Communication: Practical Strategies for Better Interactions
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Strong communication skills are essential to provide safe, quality, patient-centered care. Nurses develop therapeutic relationships with patients and family members each day to ensure that health care concerns and needs are addressed. If communication breaks down, information exchange stops and needs go unidentified. Nurses optimize communication channels with patients and families by ...
Communicating with Patients
Therapeutic communication is at the foundation of the nurse-client relationship. It is different than the conversations you have with friends, peers, family, and colleagues. Therapeutic communication has a specific purpose within the healthcare context. It is intended to develop an effective interpersonal nurse-client relationship that supports ...
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Inequality in Patient Communication. In 2003, the Institute of Medicine issued a report detailing the importance of patient-centered care and cross-cultural communication as a means of improving health care quality across patient groups 6.Differences between physicians and patients, including culture, gender, race, and religion, can introduce bias into patient-physician communication.
2.3 Communicating with Patients
2.3 Communicating with Patients Open Resources for Nursing (Open RN) Therapeutic communication is a type of professional communication used by nurses with patients and defined as, "The purposeful, interpersonal information-transmitting process through words and behaviors based on both parties' knowledge, attitudes, and skills, which leads to patient understanding and participation."
3.14: Therapeutic Communication Techniques
Hold his/her hand. Consider the cultural belief and comfort of the patient before touching. Paraphrasing. This conveys understanding of the patient's basic message. "It sounds as though the most important problem is the diet". To assist in analysis and problem solving. Acknowledge the person.
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Communication skills needed for patient-centered care include eliciting the patient's agenda with open-ended questions, especially early on; not interrupting the patient; and engaging in focused active listening. Understanding the patient's perspective of the illness and expressing empathy are key f ….
Week 3: Communication Part A
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Therapeutic Communication Techniques for NCLEX (50 Questions)
In this section are the NCLEX practice questions to help you familiarize yourself with therapeutic communication items. Included in this nursing test bank are 50 questions divided into two parts. We hope that this practice quiz will help you understand the essential elements and concepts of therapeutic communication. Quiz Guidelines.
Chapter 1: Communicate Professionally Within a Health Care Setting
Effective communication is a vital skill for nursing assistants. Nursing assistants communicate professionally with patients and other health care team members throughout every shift. This chapter will review the communication process, discuss strategies for adapting communication based on the needs of the client and health care team, and introduce guidelines for documentation and reporting.
Assignment 3 Conflict Management Completed Shadow Health
Assessing a patient's response to medication is an important nursing duty, and you need to understand how well Dr. Douglas's pain medication is working. You scored. 1 out of 1. The correct answer is: Assessing a patient's respon to medication is an importan nursing duty, and you need to understand how well Dr. Douglas's pain medication is working.

Strategies for effective patient communication

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Developing the Tools and Processes for Adaptive Targeting

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WHY COMMUNICATION MATTERS

1. MAKE A POSITIVE CONNECTION WITH THE PATIENT

2. DEMONSTRATE ACTIVE LISTENING

3. ESTABLISH A SHARED AGENDA

4. USE OPEN-ENDED QUESTIONS AND REFLECTIVE STATEMENTS

5. SOLIDIFY THE RELATIONSHIP WITH CLEAR EXPLANATIONS

POCKET GUIDE TO PATIENT COMMUNICATION

AN IMPROVED PATIENT VIGNETTE

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Nursing Assistant [Internet].

Chapter 1: Communicate Professionally Within a Health Care Setting

1.2. THE COMMUNICATION PROCESS

Verbal Messages

Nonverbal Messages

Communication Styles

Overcoming Communication Barriers

1.3. COMMUNICATION WITHIN THE HEALTH CARE TEAM