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Communication means the giving, receiving, and interpreting of information through any of the five senses by two or more interacting people.
Effective use of communication will play an important role in your nursing career and personal life.
FIGURE 44-1 · This nurse uses principles of therapeutic communication when interacting with his client.
Personal characteristics of genuineness, caring, trust, empathy, and respect promote harmony among individuals. Key Concept In some cases, the nurse has the right to request a different assignment if he or she believes that working with this client may cloud professional judgment. NCLEX Alert When reading NCLEX questions relating to communication, look for the best possible and most beneficial response for the client. Think of communication as a reciprocal process in which both the sender and the receiver of messages participate simultaneously. NCLEX Alert The NCLEX options can provide examples of comments that you might make when caring for a client. Much verbal information is related through vocabulary, sentence structure, spelling, and pronunciation.
Key Concept Remember that how you write or input data indicates information about you, as well as about the client.
Aphasia is a defect in, or loss of, the ability to speak, write, or sign, or of the ability to comprehend speech and communication. Speaking different languages may make complete and effective communication difficult, but it need not prevent interaction with others. FIGURE 44-7 · A word-and-picture card can assist in communicating with a person who has difficulty hearing or speaking or with one who speaks a language different than that of the nurse. Key Concept All interpreters must be approved by the facility before becoming involved in a client’s care.
Therapeutic communication is an interaction that is helpful and healing for one or more of the participants; the client benefits from knowing that someone cares and understands, and the nurse derives satisfaction from knowing that he or she has been helpful. He uses appropriate positioning (eye level), does not invade the client’s personal space, makes appropriate eye contact, and generally mirrors the client’s body position.
For example, a nurse whose religion forbids abortion may request not to assist in the operating room with this procedure. Therapeutic communication options typically differ from conversations that you have in a social setting. Communication can be carried out in person or by telephone, or by text messaging, alpha paging, AudioVox, Vocera transmission, or other electronic methods.
Therapeutic communication skills, such as listening, restating, silence, and so forth, might be the best form of client care.
Two types of communication are verbal communication (using words) and nonverbal communication (using facial expressions, actions, and body position).

People reveal their education, intellectual skills, interests, and ethnic, regional, or national background through verbal communication. Aphasia is usually caused by an injury or disorder of the brain’s speech centers or by a mental illness. A smile is understood in all cultures, and people can often use hand signals to communicate their needs. Speaking a few words of another language often helps the client to appreciate the nurse’s efforts.
Box 8-5 describes techniques for communication with a client who does not speak your language. Many people who do not speak the language being spoken will say they understood, even if they did not. They can provide encouragement to the client and may be able to give information to the staff. Be aware that some gestures used in the United States mean something entirely different in another country. Sometimes, each word is also written in the client’s language so the staff can learn some key words. Often a family member volunteers to help, but there are risks involved: the family member may add his or her own interpretation to what the client says or may not be able to translate medical terms correctly. Health Insurance Portability and Accountability Act (HIPAA) regulations require special training for interpreters.
Be sure to have a signed Release of Information (ROI) before disclosing any information about a client to any unapproved person. Conveying these attitudes to another person creates a social climate that communicates goodwill and empathy, even when fears or concerns cannot be fully expressed verbally. They converse with clients, write care plans, document information and assessments, input data into the electronic record, and give oral or written change-of-shift reports. Table 44-1 gives examples of such barriers and more effective responses that encourage further discussion. Speaking very slowly may be the result of a brain disorder, mental illness, or minimal knowledge of English. Expressive aphasia refers to difficulty in speaking or in finding the correct or desired word. The nurse learns a great deal about the client by carefully listening to what the person has to say. It is important to check to make sure that the client understands questions and instructions. Do not touch the client until you are sure the client understands what you are going to do. The interpreter must have documentation of this training and must be an approved volunteer or employee of the healthcare organization.

Let all clients know you care, but do not allow them to participate in dangerous or threatening behavior. Successful therapeutic communication encourages client coping and motivation toward self-care (Fig.
Pointers for using therapeutic communication are listed in the accompanying In Practice: Nursing Care Guidelines 44-1.
Effective communication occurs when words and actions convey the same message (congruency).
Although a client may say what the nurse wants to hear, his or her tone of voice may imply a totally different meaning.
However, it may also indicate conditions, such as a hearing impairment, mania, or difficulty in speaking the language. Receptive aphasia refers to a disorder of the brain that interferes with the comprehension or understanding of what one is hearing.
Listening skills also include paying attention to nonverbal cues exhibited by the client (see Fig. For example, a drawing of a toilet or bedpan may ask the question, “Do you need to use the toilet?” when you cannot ask in the client’s native language. In addition, the use of a family member or friend as an interpreter violates the client’s privacy.
To be most helpful, the nurse develops the ability to convey a nonjudgmen-tal attitude, especially if another person’s beliefs and values differ from the nurse’s own. Speaking softly may imply such things as nervousness, paranoia, shyness, or lack of self-confidence. Hesitation in speaking, thought-blocking, difficulty in finding words, or total aphasia may indicate that the client does not speak English well, has a brain disorder, or is hallucinating (seeing or hearing things that others do not perceive). A collection of drawings or photos may help the client to tell you when he or she is hungry, thirsty, cold, or in pain (Fig. Clients must experience a feeling of rapport with the nurse in order to share personal, and sometimes embarrassing, information. For example, noise, a TV playing, or other people talking in the background can distort interactions. Some people may be very fearful or may react with false bravado or become threatening or assaultive. Conducting therapeutic communication in privacy or in a quiet area helps to avoid distractions that detract from its effectiveness.

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