science

Nurse Communication (Verbal & Non-verbal)

Client communication (Verbal & Non-verbal)

Nurse’s Thoughts &

Feelings Related to the Interaction

Communication Technique (Therapeutic/Non-Therapeutic)

Alternative or Revised Response

1.

NV: At eye level and squared up to Mrs. Alverez with full eye contact.

V: I said my name is Michaela and I will be your nurse. Can I have your name and date of birth. How would you like me to address you?

NV: Mrs. Alverez was facing the window and looking outside while answering the questions with arms crossed. V: She stated that she was Lisa Alverez, and she was born April 29, 1987. She would like to be addressed as Lisa.

The patient is off and not necessarily wanting to be part of the conversations and could be potentially wanting to be out there and not part of her problems.

Therapeutic

because

Could have been more direct by saying what would you like me to call you? This might have been more direct and given the patient a better idea to what the nurse wanted.

of offering a

giving

broad opening

and

reak the

re out how he

w they ressed

the start.

wanting to b ice and figu to start to build t relationship by knowing ho want to be add to not offend the patient from

2.

NV: Remaining focused and facing the patient.

V: Lisa I noticed that you brought yourself in today and I was wondering if you could tell me more about why you brought yourself in?

NV: Still facing the window, but at times during the conversations starts to make some eye contact, but only for a second or two.

V: She states that she has noticed that she can not control her anxiety anymore and is constantly worrying about her kids and when her kids are gone, she is calling the place that they are at every 5 minutes, or she ends up picking up her children 2 hours early because they are in her sight. She also states why am I telling you this, I do

This is a step in the right direction because she is starting to describe what is going on and putting her thoughts in words but

is also trusting the nurse enough about talking something so sensitive.

Therapeutic

and it is

It was not a bad question but could have done a better evolving the relationship with more generic questions before diving into it. The nurse could have asked how you are doing today or something along those lines.

the

technique of

how

exploring

and getting

a better idea of what is

n in the s life and

nt is coping

going o person’ the patie with what is happening.

not even know you.

3.

NV: Still facing Lisa and leaning in a little bit to look intent and interested, the nurse was a little anxious about possibly make the situation worse.

V: Thank you for sharing Lisa and I noticed that you seem a little anxious to share your experience, but I hope you understand that this information stay between your care team and you. We are just wanting to try our best to help you, but we do nee to understand where your anxiety is coming from.

NV: Arms are still crossed, and she still has little to no eye contact, but she is starting to slightly turn to face the nurse.

V: I guess thank you for helping me, I just have never had anyone care about my feelings or try to understand where I am coming from. My husband works a lot and growing up my parents never cared what I did. I was gone for 5 days and they did not even notice.

Connection is starting to form, and the patient is starting to understand that the nurse is there to help, and the patient is now willing to open more.

Therapeutic

because

as trying to

sible

nding and

get the

pen more. ue was ervations.

This is a good way to have the patient understand that she is not trying to harm the patient, but it could have been better to add a question that would help get the information instead of relying on the patient to give the information.

the nurse w clear a pos misundersta was able to patient to o

The techniq making obs

4.

NV: The nurse sits there facing the patient, leaning in, and staying focused on the patient and the patient’s non-verbal’s V: I see, and what happened after those five days?

NV: Facing the nurse, sitting a little more upright and arms are now laying on top of her lap.

V: After those five days my parents became even worse. I forgot to mention I was 7 when that happen. But there was a time I became very sick and ended up with an appendicitis and I had to call my grandma to come help me. Eventually my parents showed up and showed the nurses that they were great parents and cared about me. I do not want my children to feel the same way I do.

The patient is trusting the nurse even more and the conversation is explaining more about what is going on in the patient and what might help the patient.

Therapeutic

were used,

offering a and

event in ence. niques more of an

ng and

ast that

caused the

Could have just did the general lead to get different information instead of what happened after the five days. The nurse could have just said go on.

techniques and it was general lead placing the time or sequ These tech helped get understandi about her p might have problem.

5.

NV: Still maintaining the conversation while at eye level, eye contact, and leaning in. V: I sense that you think your

NV: Patient is fully part of the conversation, full eye contact, but hands are not sitting still as conversation continues.

The conversation is still going in the right direction and the patient is willing to talk

Therapeutic

were used by

the feelings

The question could be restated by asking her feelings toward her parents and how she

techniques in this situation

restating

anxiety is based on your childhood experience and worrying about if you are there for your kids enough.

V: I guess you could say that is true, I feel bad putting the blame on my parents because they are my parents, but I was treated horribly by them.

about topics that make her uncomfortable but feels safe to let those feelings out.

of the patient and giving them a clearer picture to what they are explaining.

thinks it has impacted her parenting.

6.

NV: Still maintaining eye contact and being intrigued in the conversation. V: How do you think this anxiety is affecting you today?

NV: Maintaining eye contact with the nurse and still fully facing the nurse, silent for a few minutes thinking about how it has affected her today. V: Now that I really think about it, it has affected me a lot through my choices about myself and then my choices about my children.

This was a good question, and it made the patient truly think about her current situation and how the anxiety from her past is affecting her now.

Therapeutic

technique

The question could have been more specific about wanting specifics about what is going on instead of a general question.

and it was and tryi the relatio between her parents and her current situation.

exploring

ng to figure out nship

7.

NV: Still maintaining eye contact and being intrigued in the conversation. V: Why do you say that?

NV: Looks confused for a second about the statement, but still facing the nurse.

V: I guess my past has made me very anxious with my own children and wanting to make sure they are always okay, and it has led to forgetting to eat and feeling sick to my stomach.

This idea is interesting, and it allowed the patient to add more specifics to the pervious question.

Non-therapeutic

tting he

The response would have been better if I stated “ Yes, I see, please go on” instead of asking her why.

technique it was asking a “why” question and pu the patient on t defensive.

8.

NV: Still maintaining eye contact and being intrigued in the conversation.

V: I understand that you realize that you forgot to eat and feel sick, but do you realize that you lost 15 pounds? Don’t you realize the risk to your health by losing so much weight so quickly?

NV: She turns toward the window after the question and is staring out the window thinking.

V: (Nothing was stated)

This line of questions was not great, but it is showing that I am judging her choices.

Non-therapeutic

to

or

This could have been presented better by making it sound more empathic accusatory. I could have said “Let’s talk about your daily eating routine. Tell me what you eat on a typical day.”

technique of

. The

patient does not owe me an explanation her weight loss whether or not she understands the risks involved.

9.

NV: Still maintaining eye contact and being intrigued in the conversation and leaning in a bit more to feel she can talk and remain silenced. V: (The nurse said nothing)

NV: Lisa is starting to turn back around to the nurse and looked less defensive and calm again.

V: I did not think I lost that much, but it makes since because the only time I eat is with my children because I do not have to worry about them because they are there with me. But when they are gone and I am supposed to have me time or time with my husband, I become sick and do not feel like eating until I calm down and usually takes a couple hours after I see them. At that point I still do not feel hungry.

This action was good, and the conversation is going in the right direction again.

Therapeutic

technique

of silence. patient

k about her d what the rying to get

o

Could have asked a more specific questions about what she thinks has caused the weight loss. But the silence technique allowed the patient to think and respond the way that helps the patient more.

and the use It gave the time to thin answers an nurse was t the patient t understand.

Nurse Communication (Verbal & Non-verbal)

Client communication (Verbal & Non-verbal)

Nurse’s Thoughts &

Feelings Related to the Interaction

Communication Technique (Therapeutic/Non-Therapeutic)

Alternative or Revised Response

10.

NV: Still maintaining eye contact and being intrigued in the conversation and showing the acceptance of what the patient answered.

V: It must be very difficult for you to have to deal with so many emotions on top of the physical problems you are dealing with too.

NV: She remained in the same position of being intrigued and maintaining eye contact. But she lets out a sigh.

V: It is. But I have no idea how to control my emotions and this anxiety? And I don’t know what to do with my children. I came in to get help, what do you think I should do?

Good step in the right direction because the patient is now asking the questions out loud and is asking for the nurse’s opinion, which means there is a connection.

Therapeutic

which was the implied the patient

and what

m in and se

s the

patient is

There could have been a question instead of just a response because this could be interpreted wrong and break the trust. Could have asked if there is a relationship between the anxiety and health problems and how it could be fixed.

technique, verbalizing and having real underst brought the that the nur

understand

difficulty the having.

11.

NV: Still maintaining eye contact and being intrigued in the conversation.

V: Why don’t you tell your husband that he needs to help you more with the children.

NV: Sitting in silence, she thinks about what she could do and eventually letting out another sigh.

V: I guess that I could but I’m not sure how he really can help me since he works so much.

Not good. She seems a little upset with my comment about asking her husband to help. I think she may be shutting down.

Non-therapeutic

I could have asked her “What does your husband think about helping you more with the children when he gets home from work?

technique, giving

is

advice

. Telling the hat to do ow what

.

patient w implies I kn best for her

12.

NV: Still maintaining eye

NV: Seems unsure, but her

Patient is relaxing and

T

herapeutic

Luckily the patient

contact and being intrigued in the conversation.

V: I’m sorry. I shouldn’t have told you what to do, that is a discussion for you and your husband to have.

body is relaxing, but is still a little rigid.

V: Thank you for the apology. Yes, I think that would be a good conversation to have when I feel more rested and more like my old self. I am always tired.

can continue the conversation without the nursing asking the questions and feels comfortable asking the nurse questions.

technique, which helps the patient understand that you agree with their cho

be there to help with

the choices apologizing f her feel uncomfortable.

accepting,

g

accepted my apology so I wouldn’t have changed anything here.

ice and will

and or makin

13.

NV: Still maintaining eye contact and being intrigued in the conversation.

V: Is there something that helped you fall asleep before having children of your own or when you were younger?

NV: Thinking hard about the question, staring at the floor by the nurse’s feet, but then moves her eyes up to talk to the nurse.

V: ummm. Yes, there was, the one good thing my mom would do for me was if I woke up from a nightmare, she would offer me a nice warm cup of milk and would tell the nanny to play me a lullaby on a jewelry box I used to have.

The nurse is asking questions that makes the patient think about her life and about what would help her. This idea improves the conversation because it makes the patient feel very centered.

Therapeutic

t

The question could have made them regress and bring out more anxiety to think about their past. The question should have been, have you tried anything throughout your entire life that

might have helped a

little bit with your sleep?

technique,

encouraging

, which patient to

mething tha hem with situation for them

comparison

allows the think of so might help t their current that worked in the past.

14.

NV: Still maintaining eye contact and being intrigued in the conversation.

V: Do you think you could try this now?

NV: Has a slight smile, sitting upright, and concentrating on the nurse, and maintaining the eye contact.

V: I think I could, I do not have the jewelry box anymore. But I could probably find it on YouTube or something like that.

The patient is becoming very relaxed and the conversation is coming to answers about what will help the patient when she leaves and goes home.

Therapeutic

This question could have been a little less direct because then it may seem more like

the nurse is suggesting then allowing the patient to come up with it. The question could be changed to is there something like this that you could try?

technique, reflecting,

e

which allows the patient to restate their ideas without the nurse stating them for them. It sets patient to understand their problems and trust th nurse is listening and wanting to help.

15

NV: Still maintaining eye contact and being intrigued in the conversation.

V: That sounds like a great idea. So far, we have talked about a lot of things to try and do, are you able to restate to

NV: Sitting upright, concentrating hard on the ideas, and maintaining eye contact.

V: Yes, I can. For my anxiety away from my children I am going to start painting again to

The conversation is not an easy conversation, but it is a conversation that needs to be had to ensure that the patient understands they are

Therapeutic

a

Could get rid of the fluff and get straight to the point, to help the patient and not make them more confused. Could have said how about we restate our

technique, formulating

a plan of action

was

used and it helps the patient come up with plan that will help them with their

me what we are going to try during our anxious moments.

keep my mind busy, but to also know they are always with me. This idea should help control my anxiety and help me with eating when my kids are not around. The next thing we are going to try is the music and warm milk at night to help me fall asleep to feel that I am okay.

in good hands. But it does take some hard work for the patient to do for it to work for the patient.

problems and can bounce their ideas off the nurse. It allows a plan to be formed and ideas to be said out loud.

plan and ideas now for clarification.

16.

NV: Still maintaining eye contact and being intrigued in the conversation.

V: This is a perfect plan! You seem a little more relaxed.

NV: seems calm and has eye contract with the nurse and has a slight smile on her face and body is relaxed.

V: I am, thank you for helping me talk through my problems to come up with a plan and how I will get better for myself and for my children.

The patient is trusting the nurse and understanding the thoughts and feelings behind the nurse and that she can trust the nurse to help her with this plan.

Therapeutic

The statement was fine but could have maybe left out the last part because she is relaxed, but what was needed was the accepting part at this time in the conversation.

technique, accepting

e

nd

is used to show the patient that we agre with their decision a that it might help them.

17.

NV: Still maintaining eye contact and being intrigued in the conversation.

V: Well hang in there. All of these changes are for your own good, you will see.

NV: Looking at me with a strange look on her face. V: How do you know these changes will be good for me. You don’t know what it is like for me. I think you should leave now.

Oh boy, I shouldn’t have said that. She is right, I do not know if these changes will be good or not. And now she asked me to leave her room. I think I just lost the rapport I was building with her.

Non-therapeutic

The question could have been said in a different way that did not make it seem like the nurse knew that all of these changes would be good for her. I could have said, “What do you think of the plans so far? Do you think they are manageable?”

technique

,

making a

stereotyped comment.

Trite expressions are meaningless.

18.

NV: Still maintaining eye contact and being intrigued in the conversation.

V: I did it again, I am so sorry. You are right, I have no idea if these changes will work for you. The changes we made had a lot of your input, so what I meant was that I hope these changes we discussed will help you. Would you help writing them out to take home?

NV: She looks at the nurse with some tears in her eyes because she is upset, and I believe it is with me. V: Okay, I understand what you meant. I’m sorry that I overreacted too. I just have so much on my mind. Thank you,

I appreciate it and understand

(patient is starting to yawn

The conversation is back on track, and she realized that I did not mean any ill will but that the way I stated it did not come out the

right way. Boy, I still need to practice my communication techniques.

Therapeutic

The statement could have left out the part of having the patient remind the nurse because this brings up doubt and anxiety for the patient about being able to make

the call. This idea could cause problems and break the trust they formed.

technique, restati

ng

the plan and lettin the patient know t they are in control their treatment go

g

hat of als.

19.

NV: Still maintaining eye contact and being intrigued in the conversation.

V: You seem like you are getting tired, do you want me to go and come back later and we can work on writing out the plan together for you to take home?

NV: Her eyes are droopy, and she looks very sleepy. V: Yes, I really would like to take a nap, but would you just sit with me until I fall asleep?

The patient is trusting and is willing to fall asleep and it is important for the patient that the nurse remain there. This idea shows the trusting relationship.

Therapeutic

the

ants hat

The questions could have been restated to make the patient suggest a nap and not the nurse suggestion.

technique, making

observations

was

w that and w e the ing w

used to sho nurse sees to make sur patient is giv they need.

20.

NV: Still maintaining eye contact and being intrigued in the conversation.

V: Okay, I will remain here until you fall asleep if that will make you feel comfortable. Later I will come back and we can work on your plan.

NV: The patient relaxes down in bed and starts to close her eyes, and her body looks fully relaxed.

V: Yes, please. I just am so used to have the kids around and do not want to feel so alone. Thank you!

The relationship is full of trust, and the patient is willing to allow the nurse to help her and trusting that she will be there and advocate for her.

Therapeutic

I think it ended on a positive note.

technique, offerin

g self

was used to make

patient feel comfortable, and not used for the nurse’s sake.

the

was