Specific Core Nursing Content # 4: Communication Theory and Interpersonal Skills

Clinical Learning Outcomes

  • Demonstrate therapeutic use of self with patients, families and groups.
  • Apply therapeutic communication techniques in care practices with patients experiencing common psychiatric symptoms including disorganized speech, hallucinations, delusions, and decreased production of speech.
  • Demonstrate group participation/leadership skills.
  • Develop professional boundaries necessary for professional care giving relationships.
  • Discuss strategies for safe management of crisis situations that occur in various treatment settings incorporating principles of therapeutic communication and patient psychopathology.
  • Incorporate Patient-centered care approaches to therapeutic communication and relationship building.

Teaching Strategies

Classroom Teaching Strategies

  • Defining Therapeutic Communication

"Therapeutic communication is essential to the use of the self as an instrument of healing.  It is the use of verbal and non-verbal messages to establish a professional therapeutic nurse-client relationship that will be the context for meeting the client’s physical and psychological needs.” Williams, C.  (2004). Therapeutic Interaction in Nursing.  New Jersey:  Slack, Inc.

               Elements that characterize therapeutic communication are:

  • Developing an attitude of respect, dignity and empowerment
  • Active listening
  • Being fully present
  • Listening with the whole self
  • Empathy
  • Communicating hope
  • Developing trust
  • Good direction -communicating with intention
    - Teach difference between "Therapeutic Relationship" vs. "Social Relationship."
     Therapeutic Communication, the verbal and nonverbal exchange which enhances the trusting nurse-patient relationship, is:
    A) Patient/Client Centered, B) Goal Specific, C) Theory Based, and D) Open to Supervision  
  • Review helpful and non-helpful verbal techniques used in therapeutic communication
    • Tools for Transforming Language into Therapeutic Strength-based Communication [see appendix 3]
  • Review use of space.
  • Review principles of motivational interviewing and how it reflects patient-centered care.
       Resources found at https://motivationalinterviewing.org/art-teaching-motivational-interviewing-resource-mi-trainers
       Training activities at www.intrinsicchange.com/training-activities.html
       Other descriptions and resources at https://www.integration.samhsa.gov/clinicalpractice/motivational-interviewing
  • Review non-verbal behaviors designed to facilitate active listening:
S – Sit squarely facing the client (unless ethnic/cultural background of client discourages direct eye contact).
O – Observe an open posture.
L – Lean forward toward the client.
E – Establish eye contact (unless ethnic/cultural background of client discourages direct eye contact).
R – Relax
  • Discuss relevant nursing theorists: H. Peplau, J. Watson and J. Travelbee.
  • Understanding anxiety in communication.
    • Listening Exercise “A Thousand Words for One Picture” activity to illustrate the effect of anxiety, and the importance of feedback in effective communication [see appendix 4]

Clinical Teaching Strategies

  • Lifting the Barriers to Therapeutic Communication That May Interfere with the Nurse-Patient Relationship [see appendix 5]
    • Clinical Group Self Awareness Activity
    • Dyads and Triads Group Role Playing Activity
  • Clinical Process Recording & Analysis [see appendix 6]
  • Reflective Narrative Client-Centered Analysis

Curricular Resources

  • Pounds, K.G. (2017) A theoretical and clinical perspective on social relatedness and the patient with serious mental illness. JAPNA 23 (3), 193-199
  • For critique helpful and unhelpful communication techniques
  • Have students watch one of the movies listed, and write a brief analysis paper. [see appendix 7]
    • A Beautiful Mind (2001) Biographical drama depicts the life of math genius John Nash’s life and struggle with mental illness.
    • Wit (2001) Story of a famous professor who is diagnosed with terminal ovarian cancer and comes to terms with death on a personal level.
    • The Soloist (2009) Journalist befriends a homeless musician who turns out to be a virtuoso living with schizophrenia.

Case Studies

  • “My Name is Anne” [see appendix 8]
    This is an unfolding case study of multiple levels of therapeutic communication breakdown in the care of a hospitalized patient.  
  • The story of Legion. In Mark 5, 1-20 in the Bible, we read of a man named Legion. What does this account tell us about the experiences of a person suffering from a mental health problem? How is the person treated by society? What are their expectations? How does the fact he was “cured” before a he could conduct a rational conversation inform us about the way we should handle mental health clients?

Simulation Exercise

Setting: A psychiatric adolescent inpatient unit, in an acute hospital setting.
Scenario: A female adolescent has been admitted involuntarily to an acute psychiatric hospital for attempted suicide: acetaminophen overdose.

The listed article describes pre- and post- simulation reflection on communication skills.

Hammer, M., Fox, S., Hampton, M. D. (2014).  Use of a therapeutic communication simulation model in pre-licensure psychiatric mental health nursing: Enhancing strengths and transforming challenges. Nursing and Health 2(1), 1-8. Retrieved from  http://www.hrpub.org   DOI: 10.13189/nh.2014.020101 

Assessment Strategies

Clinical Skills Checklist

  • The student will demonstrate interpersonal and personal communication skills as clinical interventions when providing safe, comprehensive and collaborative nursing care to individuals and families suffering from mental illness and when communicating with the health care team.  (Standard 11. Communication)

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