Week 3: Communication Part A

Use clear and simple language so the client understands what you are saying.

It is best to avoid or limit medical and professional language that clients may not understand. Remember, knowledge is power; when you use language that others may not understand, it can reinforce subordination and exclusion. By speaking simply and clearly, you include clients regardless of their professional or educational point of reference.

Be an active listener. Active listening is a type of listening that shows you are engaged in the conversation and that you hear and understand what the client is saying. Active listening is important to facilitate your understanding of, and the integration of, client’s experiences, preferences, and health goals into their care.

You might show that you are an active listener by using eye contact and having an open posture. You can also use facilitation strategies that show active listening, and also encourage the client to elaborate such as, nodding, and responding by saying “uh huh” and “tell me more.” Active listening can also be demonstrated by paraphrasing what the client says, which shows that you are listening and encourages them to elaborate.

Use silence. Silence is a strategy that aids active listening. It can be beneficial in situations where the client is talking about something personal or is struggling to find the words for what they want to say. Clients may also need time to think and reflect after you have asked a question.

Sometimes silence can be uncomfortable, and professionals want to fill the void with words. It is better to show interest and understanding and give the client time to think about how they best want to say what they want to say. If the client seems to be feeling awkward about taking too much time to think, you can say “It’s ok. Take your time.”

Be empathetic. Empathy is the action of understanding another person’s emotions and experiences while suspending your own viewpoint. You have probably heard the phrases “put yourself in someone else’s shoes” or “see the world through the eyes of another person.” Being empathetic helps the client feel understood and cultivates a trusting and therapeutic relationship.

It is important to imagine what another person is experiencing. You need to be curious and demonstrate interest by responding to what the client is saying (e.g., “Tell me more. How do you feel about it?”). Don’t get caught up in following your interview guide – it’s important to let the client’s narrative shape the interview. When a client is talking about a difficult experience, you may say something such as, “That must be very difficult.”

Be honest. Part of therapeutic communication involves being authentic and truthful. In order to do so, you should be straightforward with clients while also talking to them in a compassionate manner. If you are talking about a difficult or emotionally laden topic, demonstrate compassion by sitting down, maintaining eye contact, and being aware of your vocal intonation.

Part of being honest involves avoiding false reassurance. False reassurance is when you assure or comfort the client about something that is not based on fact. When someone voices fear or anxiety, people tend to automatically respond by assuring them that everything will be okay. An example of false reassurance is when the nurse says, “it will be okay” when a client says, “I am scared I might die.” This kind of response is not honest and does not open up communication. It is more effective and honest to say, “tell me more.” See Film Clip 2.3 demonstrating false reassurance and Film Clip 2.4 on how to avoid false reassurance.

You should also avoid distancing and avoidance language. Distancing is when you attempt to create a false space/distance between a threat and the person (e.g., “the cancer has spread to your brain” as opposed to “your cancer…”). Avoidance language is unclear language (e.g., “your partner didn’t make it” or “they are now at peace”). It’s better to use specific language (e.g., “your partner died”). Being direct demonstrates honesty and ensures clarity for the client.

Demonstrate unconditional positive regard, which means accepting and respecting that each client has agency to believe and behave how they want, or feel is best. You don’t have to agree or approve, but your acceptance of their self-determination should not be conditional on its alignment with your beliefs or behaviors.

Using this approach involves accepting that clients are generally doing the best they can. Avoid judging or blaming them for their beliefs, behaviors, or conditions. You should avoid questions that begin with “why” as this can imply blame. For example, avoid “why do you smoke?” You can reframe this inquiry as, “tell me about the reasons that you smoke.”

Use permission statements to open conversations that may be difficult to talk about. Permission statements are a combination of statements and questions that suggest to the client that an experience or feeling is expected or normal.

One example of a permission statement is: “Often, children your age experience changes in their body that they have questions about.” Another example is: “Clients that have experienced your type of surgery often have questions about sex. Do you have any questions for me?” Another example is: “Many people your age begin to experience problems with urinary incontinence, have you had any issues?”

Ask one question at a time so that the client understands it and so that you are more likely to receive a clear answer.

You should avoid asking multiple questions at once because this can be confusing for clients. Here is an example: “Tell me about your support system. Your brother seems like he’s a great help, right? Do you have anyone else to support you?” Instead, try it this way to start: “Tell me about your support system?” – then, wait for an answer. You can probe with follow-up questions depending on what the client says.

Be conscious of how your vocal qualities influence nurse-client communication. Vocal qualities refer to intonation, speed, and rhythm.

These vocal qualities influence the communication process in terms of the emotions you convey and your interest in the conversation, as well as how a client interprets what is important. For example, speaking quickly can be interpreted as the nurse being in a rush to leave.

Work collaboratively with the client during the interview so that they are an active agent with self-determination. By using a relational inquiry approach and working collaboratively, you can focus on what is important to the client.

Part of focusing on what is important to the client involves providing information that they identify as relevant to them. Avoid being authoritative and giving unwanted advice, but it’s a good idea to ask if the client is interested in learning more about a topic.