Communicationis the process that people use to
exchange information. Messages are simultaneously
sent and received on two levels: verbally through
the use of words and nonverbally by behaviors that
accompany the words (Balzer Riley, 2000).
Verbal communicationconsists of the words a
person uses to speak to one or more listeners. Words
are symbols used to identify the objects and concepts
being discussed. Placement of words into phrases and
sentences that are understandable to both speaker
and listener gives an order and a meaning to these
symbols. Contentis verbal communication, the lit-
eral words that a person speaks. Contextis the envi-
ronment in which communication occurs and can
include the time and the physical, social, emotional,
and cultural environment (Weaver, 1996). Context
includes the circumstances or parts that clarify the
meaning of the content of the message. It is discussed
in more detail throughout this chapter.
Nonverbal communicationis the behavior that
accompanies verbal content such as body language,
eye contact, facial expression, tone of voice, speed and
hesitations in speech, grunts and groans, and distance
from the listener. Nonverbal communication can indi-
cate the speaker’s thoughts, feelings, needs, and values
that the speaker acts out mostly unconsciously.
Processdenotes all nonverbal messages that
the speaker uses to give meaning and context to the
message. The process component of communication
requires the listener to observe the behaviors and
sounds that accent the words and to interpret the
speaker’s nonverbal behaviors to assess whether they
agree or disagree with the verbal content. A congru-
ent messageis when content and process agree. For
example, a client says, “I know I haven’t been myself.
I need help.” She has a sad facial expression and a
genuine and sincere voice tone. The process validates
the content as being true. But when the content and
process disagree—when what the speaker says and
what he or she does do not agree—the speaker is giv-
ing an incongruent message.For example, if the
client says, “I’m here to get help” but has a rigid pos-
ture, clenched fists, an agitated and frowning facial
expression, and snarls the words through clenched
teeth, the message is incongruent. The process or ob-
served behavior invalidates what the speaker says
(content).
Nonverbal process represents a more accurate
message than does verbal content. “I’m sorry I yelled
and screamed at you” is readily believable when the
speaker has a slumped posture, a resigned voice tone,
downcast eyes, and a shameful facial expression,
because the content and process are congruent. The
same sentence said in a loud voice tone and with
raised eyebrows, a piercing gaze, an insulted facial
expression, hands on hips, and outraged body lan-
guage invalidates the words (incongruent message).
The message conveyed is “I’m apologizing because
I think I have to. I’m not really sorry.”WHAT IS THERAPEUTIC
COMMUNICATION?
Therapeutic communicationis an interpersonal
interaction between the nurse and client during which
the nurse focuses on the client’s specific needs to pro-
mote an effective exchange of information. Skilled use
of therapeutic communication techniques helps the
nurse understand and empathize with the client’s ex-
perience. All nurses need skills in therapeutic com-
munication to effectively apply the nursing process
and to meet standards of care for their clients.
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 unfolded. 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 emotions.
- Teach the client and family necessary self-
care skills. - Recognize the client’s needs.
- Implement interventions designed to address
the client’s needs. - Guide the client toward identifying a plan of
action to a satisfying and socially acceptable
resolution.
Establishing a therapeutic relationship is one of
the most important responsibilities of the nurse when
working with clients. Communication is the means by
which a therapeutic relationship is initiated, main-
tained, and terminated. The therapeutic relationship
is discussed in depth in Chapter 5 including confiden-
tiality, self-disclosure, and therapeutic use of self. To
have effective therapeutic communication, the nurse
also must consider privacy and respect of boundaries,
use of touch, and active listening and observation.
Privacy and Respecting Boundaries
Privacy is desirable but not always possible in ther-
apeutic communication. An interview or conference
room is optimal if the nurse believes this setting is not
too isolative for the interaction. The nurse also can
talk with the client at the end of the hall or in a quiet
corner of the day room or lobby, depending on the phys-
ical layout of the setting. The nurse needs to evaluate112 Unit 2 BUILDING THENURSE–CLIENTRELATIONSHIP