• Therapeutic communication is the foundation of an effective nurse–client relationship; it helps reduce stress, encourage insight, and support problem solving.
• Therapeutic communication involves both verbal and nonverbal communication.
• The nurse’s use of therapeutic communication with clients and other nurses is essential for effective use of the nursing process. See Table 11–1 for the communication factors that influence the steps of the nursing process.
• The nurse builds a rapport with clients to further the nurse–client relationship. Good rapport facilitates open communication. See Table 11–2 for factors that promote trust in the nurse–client relationship.
• The nurse promotes trust by respecting the client’s personal values, beliefs, and culture.
• The nurse maintains the client’s culture by providing a language interpreter and including other members of the
health care team who share the client’s culture to assist in providing care.
• The nurse develops and maintains therapeutic relationships with the client, family, and significant others by allowing ample time for communication. He/she communicates and delivers care in an unhurried and
• The nurse uses active listening, silence, touch, and humor to facilitate communication with the client, family, and significant others.
• Open-ended questions by the nurse encourage free verbalization from the client. This provides the nurse with specific, additional information that forms a basis for the plan of care.
• Therapeutic communication techniques provide support to the client, family, and significant others. for therapeutic communication techniques.
• Barriers to therapeutic communication negatively impact the nurse–client relationship. See Table 11–4 for barriers to therapeutic communication.
• Impaired verbal communication (NANDA nursing diagnosis) can affect every aspect of the client’s life.
—Impaired verbal communication is the state in which an individual experiences a decreased or absent ability to use or understand human language.
—Communication in the older adult may be affected by
■ aphasia: the inability to recall words, understand what others are saying, or produce speech,
■ dysarthria: the inability to produce clear speech sounds,
■ voice problems: due to malfunction or removal of the larynx (voice box),
■ hearing impairment: presbycusis (hearing loss due to aging process); may hear speech, but is unable to understand distinct words or sounds,
■ other problems: memory loss, disorientation, loss of thought organization.
• Clients with special needs require specific communication techniques.
—Visually impaired: Speak in a normal tone of voice; explain the reason for touching the client before doing so; keep the call light within easy reach; clean eyeglasses and confirm contacts are in place.
—Hearing impaired: Face the client while speaking; demonstrate or pantomime ideas as appropriate; write ideas or use sign language; clean hearing aids and confirm proper placement.
—Cognitively impaired: Maintain eye contact; keep communication simple and concrete; avoid open-ended questions; be client and allow time for the client’s responses.
—Unconscious client: The client can most likely hear even though there is no apparent response; assume the client can hear you; talk in a normal tone of voice; speak with the client before touching.
—Client with a physical barrier (laryngectomy or endotrachea tube): Select a simple means of communication,
such as eye blinks or hand squeezes; ensure that family and significant others are able to utilize the selected
communication technique; allow time for the client’s responses; ensure the client has an effective means of signaling for assistance (call bell or alarm).
—Non-English speaking clients: Use an interpreter; speak in a normal tone of voice; speak in simple sentences; demonstrate or pantomime ideas; use accepting nonverbal communication cues.