CASE NO.

1
Mrs. Maria Ramirez, 45 y.o. married, is faced with difficult decision of whether or not to continue chemotherapy in the face of a rapidly spreading malignancy. What communication technique could the nurse use to help her at this point, and what traps must the nurse avoid in such a situation?

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Needs Identified:

Mrs. Maria Ramirez is confused about whether she will continue or stop her chemotherapy.

Therapeutic communication begins with the nurse showing respect for the patient and family members and recognizing that communication includes not only verbal responses but also nonverbal expressions, such as tone of voice, body language and facial expression.
The nurse must listen and observe carefully and use communication techniques that promote better communication in order to understand the needs and feelings of the patient.

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USE NAMES

"Mrs. Ramirez, I am John Stevens, your nurse." Using a person's name makes her feel more valued, and introducing yourself is a basic step in establishing a therapeutic interaction.

SHOW EMPATHY

You should be honest with the patient and acknowledge his concerns and feelings, answering questions as completely as possible. Sometimes the patient's nonverbal behavior can communicate more than words. Making observations about what you see can encourage communication: "Mr. Ramirez, your hands are shaking. You seem upset."

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PROVIDE ENCOURAGEMENT

Patients often want to talk about their concerns but are reluctant to impose on your time or feel intimidated. Open-ended questioning may facilitate communication: "Mrs. Ramirez, do you have concerns you'd like to talk about?" Don't be afraid to allow periods of silence and encourage the patient by brief acknowledgments, such as "Yes" or "I see."

Use your own body language, leaning forward and nodding your head, to promote communication. Listen for the implied meanings and encourage people to express them: "When you say there's no point in chemotherapy, does that mean that your illness is not under control?"

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HELP TO ORIENT

Illness and hospitalization can be very disorienting for patients, especially the elderly. You should tell the patient what is real without challenging her.

INCLUDE THE PATIENT

You must remember that patient care should be collaborative and include the patient in decision making whenever possible. The patient often feels at the mercy of the system, but you can help him find ways to feel in control.

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RECOGNIZE LIMITS

You should never try to force the patient to talk or express feelings until he is ready. If the patient doesn't answer a question or chooses not to discuss feelings, back off. Respect the patient's right to silence. You can indicate an openness to talk: "I'm happy to talk with you about your treatments when you like.

SILENCE

Moments of silence give the nurse and patient time to sort their feelings and think about what's already been communicated. The nurse should let the patient break the silence.

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USING TOUCH

Touching is a powerful way to communicate. It can relax or comfort a patient. Nurses need to be sensitive to patients and ascertain whether touching is acceptable, since some patients may feel threatened by it.

ASKING QUESTIONS Asking relevant questions allows the nurse to gather important information. A nurse should ask only one open-ended question at a time. An example is "What is your biggest problem right now? BLOCKS

Some techniques are non-therapeutic and block communication. Nurses should not ask personal questions, give personal opinions, change the subject or give false reassurances. Neither should they argue, offer approval or disapproval, or ask for explanations.