process of sharing information and meaning, of sending

and receiving messages.

NON-VERBAL - the behavior that accompanies verbal
content

VERBAL - consists of words a person uses to speak to one

or more listeners
Appearance
Uniform, name tag, neat and NOT extreme hairstyle, short and
neat nails, minimal jewelry
Demeanor
Professional, poised, not overwhelmingly touchy or friendly

Attitude
Non-judgmental

Facial expression
Neutral expression
EXPRESSIVE – portrays the person’s moment-by-moment
thoughts, feelings and needs.

IMPASSIVE – frozen into emotionless deadpan expression.

CONFUSING – expression is one that is the opposite of

what the person wants to convey.
Silence
Allow client to reflect and organize thoughts
May indicate that the client is thoughtfully considering the question
before responding.
Allow the client sufficient time to respond.
It may indicate that the client is depressed and struggling to find
energy to talk.
Not paying attention.
Listening
Most important skill; maintain eye contact, appropriate facial
expression, open body position
Avoid:
 crossing your arms
 sitting back
 tilting your head away from the client
 thinking about other things
 looking blank or inattentive
Watch the speaker’s non verbal actions as he or she communicates.
S=sit squarely facing the client

O=open posture when interacting with the client

L=lean forward toward the client

E=establish eye contact

R=relax
S=sit squarely facing the client

O=open posture when interacting with the client

L=lean forward toward the client

E=establish eye contact

R=relax
Vocal Cues
Describe the quality of the voice and its inflections, tone, intensity,
and speed when speaking
Calm, reassuring, and without inflections that convey judgment or
disapproval.
Speak slowly enough and loudly enough
Voice characteristics usually reflect underlying feelings
Eye Contact
used to assess the other person and the environment
indicates whose turn it to speak
increases during listening but decreases while speaking.
Body Language
Keep posture relaxed to convey a calm, reassuring attitude
Use reaffirming gestures (nodding)
Work at the same level as your client
Touch
Although touch can be comforting and therapeutic, it is an invasion
of intimate or personal space.
When the nurse is going to touch the client while performing nursing
care, he or she must verbally prepare the client before starting the
procedure.
Distraction and distance
Try to avoid physical distance exceeding 2 to 3feet

Standing
Standing puts the nurse and the client at different levels

Excessive or insufficient eye contact

Establish eye contact when the client is speaking to the nurse, but
look down at the nurse’s notes once in a while
Closed questions
Used in directive interview; restrictive
Generally require only “yes’ or “no” or short factual answers
Used in emergency situation or when the client is highly stressed or has
difficulty communicating
“What medication did you take?”

Open-ended questions
Used in nondirective interview
Invite clients to discover and explore, elaborate, clarify, or illustrate
their thoughts or feelings.
May begin with “what or how”
“How have you been feeling lately?”
Neutral questions
Can be answered without direction or pressure from the interviewer
Open-ended
Used in nondirective interviews

Leading question
Usually closed; used in directive interview
May create a problem because a client may give inaccurate
responses in order to please the nurse
Laundry list
Provides the client with a choice of words to choose from in
describing symptoms, conditions or feelings

Redirecting
helps keep the communication goal-directed
useful if the client goes off topic.
 “Getting back to what brought you to the hospital . . .”
Rephrasing
Helps to clarify information the client has stated
“You are thinking that you have a serious illness?”

Well-placed phrases
Encourages verbalization
uhhhmmm..”

Inferring
Helps to elicit the most accurate data possible from the client

Providing information
Biased or leading questions
Cause the client to provide answers that may or may not be true

Rushing through the interview

Client may no be able to hear each question clearly
Causes important information to be left out of the health history

Reading the questions

Deflects attention from the client and may result in an impersonal
interview process
Gerontologic considerations
Hearing loss speak slowly, face the client, speak on the side of the
good ear
Older clients have more health concerns than younger clients 
assure confidentiality; show client that he/she is a partner in her
care plan
Speak clearly and use straightforward language  ask questions in
simple terms, avoid medical jargon
Show respect  do not be condescending
Have a significant other present during the interview to clarify data
Cultural variations
Reluctance to reveal personal information to strangers for various
culturally-based reasons
Variation in willingness to openly express emotional distress or pain
Language barriers
Variation in use and meaning of non-verbal communication
 Eye contact
 Stance
 Touch
 Distance
Variation in illness perception
 Kulam, pasma, usog etc
Variation in the family’s role in the decision-making process
 The parent or spouse makes the decisions
Emotional variations
Anxious client
 Explain role of nurse
 Simple concise questions
 Do not hurry and decrease external stimuli
Angry client
 Approach in a calm, reassuring and in-control manner
 Allow to ventilate feelings
 Obtain help from other health professionals as needed
 Avoid arguing and facilitate personal space
Emotional variations
Depressed client
 Express interest in and understanding of the client and respond in a neutral
manner
 Do not try to communicate in an upbeat, encouraging manner
Manipulative client
 Provide structure and set limits
 Differentiate manipulation and a reasonable request
Seductive client
 Set firm limits on overt sexual behavior and avoid responding
Issues on dying, sexuality and spirituality
Be aware of own thoughts and feelings regarding the issue and
recognize that these factors may affect the client’s health
Ask simple questions in a nonjudgmental manner
Allow for ventilation of client’s feelings as needed
Refer the client to a counselor or another competent personnel if
there is a question of bias on the part of the nurse
Offering Self
Making self-available and showing interest and concern.
“I will walk with you”
Active listening
Paying close attention to what the patient is saying by observing
both verbal and non-verbal cues.
Maintaining eye contact and making verbal remarks to clarify and
encourage further communication.
SOLER
Exploring
“Tell me more about your son”
Giving broad openings
“What do you want to talk about today?”
Silence
Planned absence of verbal remarks to allow patient and nurse to
think over what is being discussed and to say more.
Stating the observed
verbalizing what is observed in the patient to, for validation and to
encourage discussion
“You sound /look upset”
Encouraging comparisons
Asking to describe similarities and differences among feelings,
behaviors, and events.
 “Can you tell me what makes you more comfortable, working by
yourself or working as a member of a team?”
Identifying themes
Asking to identify recurring thoughts, feelings, and behaviors.
“When do you always feel the need to check the locks and doors?”
Summarizing
Reviewing the main points of discussions and making appropriate
conclusions.
“During this meeting, we discussed about what you will do when you
feel the urge to hurt yourself again and this include…”
Placing the event in time or sequence
Asking for relationship among events.
“When do you begin to experience this ticks? Before or after you
entered grade school?”
Encouraging descriptions of perceptions
Asking the patient to describe feelings, perceptions and views of
their situations.
“What are these voices telling you to do?”
Presenting reality or confronting
Stating what is real and what is not without arguing with the
patient.
“I know you hear these voices but I do not hear them”.
“I am your nurse, and this is a hospital and not a beach resort.
Seeking clarification
Asking patient to restate, elaborate, or give examples of ideas or
feelings to seek clarification of what is unclear.
“I am not familiar with your work, can you describe it further for
me”.
“I don’t think I understand what you are saying”.
Verbalizing the implied
Rephrasing the patient’s words to highlight an underlying message to
clarify statements.
Patient: “I won’t be bothering you anymore soon.”
Nurse: “Are you thinking of killing yourself?”
Reflecting
Throwing back the patient’s statement in a form of question helps
the patient identify feelings.
Patient: “I think I should leave now.”
Nurse: “Do you think you should leave now?”
Restating
Repeating the exact words of patients to remind them of what they
said and to let them know they are heard.
Patient: “I can’t sleep. I stay awake all night.”
Nurse: “You can’t sleep at night?”
General leads
Using neutral expressions to encourage patients to continue talking.
“Go on…”
“You were saying…”
Asking question
Using open-ended questions to achieve relevance and depth in
discussion.
“How did you feel when the doctor told you that you are ready for
discharge soon?”
Empathy
Recognizing and acknowledging patient’s feelings.
“It’s hard to begin to live alone when you have been married for
more than thirty years”.
Focusing
Pursuing a topic until its meaning or importance is clear.
“Let us talk more about your best friend in college”
“You were saying…”
Interpreting
Providing a view of the meaning or importance of something.
Patient: “I always take this towel wherever I go.”
Nurse: “That towel must always be with you.”
Encouraging evaluation
Asking for patients views of the meaning or importance of
something.
“What do you think led the court to commit you here?”
“Can you tell me the reasons you don’t want to be discharged?
Suggesting collaboration
Offering to help patients solve problems.
“Perhaps you can discuss this with your children so they will know
how you feel and what you want”.
Encouraging goal setting
Asking patient to decide on the type of change needed.
“What do you think about the things you have to change in
yourself?”
Encouraging formulation of a plan of action
Probing for step by step actions that will be needed.
“If you decide to leave home when your husband beat you again
what will you do next?”
Encouraging decisions
Asking patients to make a choice among options.
“Given all these choices, what would you prefer to do?”
Encouraging consideration of options
Asking patients to consider the pros and cons of possible options.
“Have you thought of the possible effects of your decision to you
and your family?”
Giving information
Providing information that will help patients make better choices.
“Nobody deserves to be beaten and there are people who can help
and places to go when you do not feel safe at home anymore”.
Limit setting
Discouraging nonproductive feelings and behaviors, and encouraging
productive ones.
“Please stop now. If you don’t, I will ask you to leave the group and
go to your room.”
Supportive confrontation
Acknowledging the difficulty in changing, but pushing for action.
“I understand you feel rejected when your children sent you here
but if you look at it this way…”
Role playing
Practicing behaviors for specific situations, both the nurse and
patient play particular role.
“I’ll play your mother, tell me exactly what would you say when we
meet on Sunday”.
Rehearsing
Asking the patient for a verbal description of what will be said or
done in a particular situation.
“Supposing you meet these people again, how would you respond to
them when they ask you to join them for a drink?”.
Feedback
Pointing out specific behaviors and giving impressions of reactions.
“I see you combed your hair today”.
Encouraging evaluation
 Asking patients to evaluate their actions and their outcomes.
“What did you feel after participating in the group therapy?”
Reinforcement
Giving feedback on positive behaviors.
“Everyone was able to give their options when we talked one by one
and each of waited patiently for our turn to speak”.
Overloading
talking rapidly, changing subjects too often, and asking for more
information than can be absorbed at one time.
“What’s your name? I see you like sports. Where do you live?”
Value Judgment
giving one’s own opinion, evaluating, moralizing or implying one’s
values by using words such as “nice”, “bad”, “right”, “wrong”,
“should” and “ought”.
“You shouldn’t do that, its wrong”
Incongruence
sending verbal and non-verbal messages that contradict one
another.
The nurse tells the patient “I’d like to spend time with you” and
then walks away.
Underloading
remaining silent and unresponsive, not picking up cues, and failing
to give feedback.
The patient asks the nurse a question, but the nurse simply walks
away ignoring the client’s question.
False reassurance/ agreement
Using cliché to reassure client.
“It’s going to be alright”.
Invalidation
Ignoring or denying another’s presence, thoughts, or feelings.
Client says, “How are you?” The nurse responds, “I can’t talk now.
I’m too busy.”
Focusing on self
responding in a way that focuses attention to the nurse instead of
the client.
The patient says, “Thank God it’s sunny today.” The nurse responds,
“This sunshine is good for my roses. I have a beautiful rose garden”.
Changing the subject
introducing new topic
inappropriately, a pattern that may indicate anxiety.
The client is crying, when the nurse asks “How many children do you
have?”
Giving advice
telling the client what to do, giving opinions or making decisions for
the client, implies client cannot handle his or her own life decisions
and that the nurse is accepting responsibility.
“If I were you… Or it would be better if you do it this way…”
Internal validation
making an assumption about the meaning of someone else’s
behavior that is not validated by the other person (jumping into
conclusion).
The nurse sees a suicidal clients smiling and tells another nurse the
patient is in good mood.
Defending – “Your doctor is very good.”

Requesting an explanation – “Why did you do that?”

Reflecting – “You are not supposed to talk like that!”

Literal responses – “If you feel empty then you should eat
more.”

Looking too busy.

Appearing uncomfortable in silence.

Being opinionated.
Avoiding sensitive topics

Arguing and telling the client is wrong

Having a closed posture-crossing arms on chest

Making false promises – “I’ll make sure to call you when

you get home.”
Ignoring the patient – “I can’t talk to you right now”

Making sarcastic remarks

Laughing nervously

Showing disapproval – “You should not do those things.”