Nurse: “How long agodid your husband die?”
(Or the nurse can use the other cue.)
Nurse: “Tell me about yourhusband’s death,
Mrs. Venezia.”
Theme of loss of control:
Client: “I had a fender bender this morning. I’m
OK. I lost my wallet, and I have to go to the bank to
cover a check I wrote last night. I can’t get in contact
with my husband at work. I don’t know where to
start.”
Nurse: “I sense you feel out of control.” (trans-
lating into feelings)
Clients may use many word patterns to cue the lis-
tener to their intent. Overt cuesare clear statements
of intent such as, “I want to die.” The message is clear
that the client is thinking of suicide or self-harm.
Covert cuesare vague or hidden messages that need
interpretation and exploration—for example, if a client
says, “Nothing can help me.” The nurse is unsure, but
it sounds as if the client might be saying he feels so
hopeless and helpless that he plans to commit suicide.
The nurse can explore this covert cue to clarify the
client’s intent and to protect the client. Most suicidal
people are ambivalent about whether to live or die and
often admit their plan when directly asked about it.
When the nurse suspects self-harm or suicide, he or
she uses a yes /no question to elicit a clear response.
Theme of hopelessness and suicidal ideation:
Client: “Life is hard. I want it to be done. There
is no rest. Sleep, sleep is good... forever.”
Nurse: “I hear you saying things seem hopeless. I
wonder if you are planning to kill yourself.”(verbal-
izing the implied)
Other word patterns that need further clarifica-
tion for meaning include metaphors, proverbs, and
clichés. When a client uses these figures of speech, the
nurse must follow up with questions to clarify what
the client is trying to say.
A metaphoris a phrase that describes an object
or situation by comparing it to something else familiar.
Client: “My son’s bedroom looks like a bomb
went off.”
Nurse:“You’re saying your son is not very neat.”
(verbalizing the implied)
Client: “My mind is like mashed potatoes.”
Nurse: “I sense you find it difficult to put thoughts
together.”(translating into feelings)
Proverbsare old, accepted sayings with gener-
ally accepted meanings.
Client: “People who live in glass houses shouldn’t
throw stones.”
Nurse: “Who do you believe is criticizing you
but actually has similar problems?” (encouraging
description of perception)
A clichéis an expression that has become trite
and generally conveys a stereotype. For example, if
a client says “she has more guts than brains,” the
implication is that the speaker thinks the woman to
whom he or she refers is not smart, acts before think-
ing, or has no common sense. The nurse can clarify
what the client means by saying, “Give me one exam-
ple of how you see Mary as having more guts than
brains” (focusing).NONVERBAL COMMUNICATION
SKILLS
Nonverbal communication is behavior that a person
exhibits while delivering verbal content. It includes
facial expression, eye contact, space, time, boundaries,
and body movements. Nonverbal communication is as
important, if not more so, than verbal communication.
It is estimated that one-third of meaning is transmit-
ted by words and two-thirds is communicated non-
verbally. The speaker may verbalize what he or she
thinks the listener wants to hear, while nonverbal
communication conveys the speaker’s actual meaning.
Nonverbal communication involves the unconscious
mind acting out emotions related to the verbal con-
tent, the situation, the environment, and the relation-
ship between the speaker and the listener.
Knapp and Hall (2002) list the ways in which
nonverbal messages accompany verbal messages:- Accent: using flashing eyes or hand movements
- Complement: giving quizzical looks, nodding
- Contradict: rolling eyes to demonstrate that
the meaning is the opposite of what one
is saying - Regulate: taking a deep breath to demonstrate
readiness to speak, using “and uh” to signal
the wish to continue speaking - Repeat: using nonverbal behaviors to augment
the verbal message such as shrugging after
saying, “Who knows?” - Substitute: using culturally determined body
movements that stand in for words such as
pumping the arm up and down with a closed
fist to indicate success
Facial Expression
The human face produces the most visible, com-
plex, and sometimes confusing nonverbal messages
(Weaver, 1996). Facial movements connect with words
to illustrate meaning; this connection demonstrates
the speaker’s internal dialogue (Arnold & Boggs, 1999;
Schrank, 1998). Facial expressions can be categorized
into expressive, impassive, and confusing:- An expressiveface portrays the person’s
moment-by-moment thoughts, feelings, and
needs. These expressions may be evident
even when the person does not want to
reveal his or her emotions.
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