U.S.-Style Nursing Communication

An issue of special concern for international nurses is therapeutic communication. Correctly answering the questions about communication can be difficult for some nurses educated in the United States. These questions become a special challenge to test takers for whom English is a second language, or for test takers who do not yet fully understand American-style communication.

Key features of U.S.-style communication in nursing:

• Validate the client’s experience and feelings by responding to the client verbally. Ask questions that relate directly to what the client says.
• Direct the client’s behavior to promote comfort and well-being. Do not patronize or reject the client by imposing a value judgment.
• Maintain eye contact with the client, especially during conversation. Lean forward to face the client. Nod, smile, or frown to demonstrate agreement or disagreement while listening.

Responses used in U.S. nursing are based on an assessment of the client’s needs and are designed to foster growth and establish mutually formulated goals.

NCLEX-RN^® exam questions concerning communication are best answered by:

• Conveying respect and warmth, making the client feel accepted and respected as an individual regardless of his or her words, actions, or behavior. This means that the nurse:
  • Assumes that all client behavior is purposeful and has meaning even though it may not make sense to others
  • Defines the social, physical, and emotional boundaries of the nurse-client relationship
  • Develops a contract with the client
  • Structures time to develop a nurse-client relationship
  • Creates a safe and secure environment
  • Accepts the dependency needs of the client while encouraging, assisting, and supporting movement toward health and independence
  • Intervenes when a client behaves inappropriately to directly reject the behavior but not the client
  • Intervenes directly to respond to the client, not to reinforce an inappropriate behavior
• Demonstrating active listening and genuineness. This means that the nurse:
  • Asks questions that relate directly to what the client says
  • Maintains good eye contact
  • Leans forward in the chair to face the client
  • Nods, smiles, or frowns to show agreement or disagreement
  • Understands that the personal feelings and past experiences of the nurse can negatively or positively affect relationships with clients
• Communicating interest and empathy by allowing the client to comfortably communicate concerns and behave in new ways. This means that the nurse:
  • Focuses conversation on the client’s feelings
  • Understands that clients respond to the behavioral expectations of the nursing staff
  • Validates the client’s feelings
  • Analyzes both verbal and nonverbal behavioral clues
  • Anticipates that there might be some difficulty as the client learns new behaviors

Nurses create barriers in the communication process when they demonstrate a poor understanding of the basics in therapeutic communication. They must convey respect, warmth, and genuineness through active listening and communicating interest and empathy about the concerns of clients, families, and/or staff.

Examples of barriers to communication:

• Minimizing concerns
• Giving false reassurance
• Giving approval
• Rejecting the person, not the behavior
• Choosing sides with the client, family member, or staff member in a conflict
• Blaming the external environment for the situation
• Disagreeing or arguing with the client or family member
• Offering advice about a situation
• Pressuring the client or family member for an explanation
• Defending one’s own actions or behavior
• Belittling client, family member, or staff concerns
• Giving one-word responses to questions
• Using denial
• Interpreting or analyzing both verbal and nonverbal behavioral clues in the situation to the client
• Shifting the focus of the conversation away from the client, family member, or staff concerns
• Using jargon or medical terminology without explanation in conversation with the client and/or family
• Invalidating the client’s, family member’s, or staff’s feelings
• Offering unrealistic hope for the future
• Ignoring client clues to help the client set appropriate limits on his or her behavior

The following are some questions that will allow you to practice the right approach.