Psychiatric Mental Health Nursing by Videbeck

122 Unit 2 BUILDING THENURSE–CLIENTRELATIONSHIP

• An impassiveface is frozen into an emotion-
  less, deadpan expression similar to a mask.
  •A confusingfacial expression is one that is the
  opposite of what the person wants to convey.
  A person who is verbally expressing sad or
  angry feelings while smiling is an example of
  a confusing facial expression. (Cormier et al.,
  1997; Northouse & Northouse, 1998).
  Facial expressions often can affect the listener’s
  response. Strong and emotional facial expressions can
  persuade the listener to believe the message. For ex-
  ample, by appearing perplexed and confused, a client
  could manipulate the nurse into staying longer than
  scheduled. Facial expressions such as happy, sad, em-
  barrassed, or angry usually have the same meaning
  across cultures, but the nurse should identify the
  facial expression and ask the client to validate the
  nurse’s interpretation of it—for instance, “You’re smil-
  ing, but I sense you are very angry” (Schrank, 1998).
  Frowns, smiles, puzzlement, relief, fear, surprise,
  and anger are common facial communication signals.
  Looking away, not meeting the speaker’s eyes, and
  yawning indicate that the listener is disinterested,
  lying, or bored. To ensure the accuracy of information,
  the nurse identifies the nonverbal communication and
  checks its congruency with the content (van Servellen,
  1997). An example is “Mr. Jones, you said everything
  is fine today, yet you frowned as you spoke. I sense that
  everything is not really fine” (verbalizing the implied).

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 ac-
cepting. A better, more accepting body position is to sit
facing the client with both feet on the floor, knees par-
allel, hands at the side of the body, and legs uncrossed
or crossed only at the ankle. This open posture demon-
strates unconditional positive regard, trusting, caring,
and acceptance. The nurse indicates interest in and
acceptance of the client by facing and slightly leaning
toward him or her while maintaining nonthreatening
eye contact.
Hand gestures add meaning to the content. A
slight lift of the hand from the arm of a chair can punc-
tuate or strengthen the meaning of words. Holding
both hands with palms up while shrugging the shoul-
ders often means “I don’t know.” Some people use
many hand gestures to demonstrate or act out what
they are saying, while others use very few gestures.
The positioning of the nurse and client in relation
to each other is also important. Sitting beside or across
from the client can put the client at ease, while sitting

Closed body position

Accepting body position

behind a desk (creating a physical barrier) can in-

crease the formality of the setting and may decrease

the client’s willingness to open up and communicate

freely. The nurse may wish to create a more formal

setting with some clients, however, such as those who

have difficulty maintaining boundaries.