Communication - Sometimes called effective communication,

The sending and receiving of a message. it is purposeful and goal-oriented, creating a

beneficial outcome for the client.
Aspects of Communication
 Sender - the one who conveys the message Goals of Therapeutic Communication
to another person.  To obtain or provide information
 Message - the thought, idea, or emotion  To develop trust
conveyed.  To show caring
 Channel - how the message is sent.  To explore feelings
 Receiver - physiological/ psychological
components. Components of Therapeutic Communication
 Feedback - the receiver’s response to the 1. Trust- Without trust a nurse-client
sender. relationship would not be established and
 Influences - Culture, education, emotions interventions won’t be successful.
and other factors involved.
2. Empathy- is the nurse’s ability to perceive
Methods of Communication the meanings and feelings of the client and
 Verbal - Speaking, Listening, Writing, communicate that understanding to the
Reading. client. It is simply being able to put oneself
 Nonverbal - Gestures, Facial Expressions, in the client’s shoes. 
Posture and Gait, Tone of Voice, Touch, Eye
Contact, Body Position, Physical 3. Acceptance- A nurse, who does not judge
Appearance. the client or person no matter what his or
her behavior, is showing acceptance.
Influences on Communication Acceptance does not mean accepting all
 Age the inappropriate behavior but rather
 Education acceptance of the person as worthy.
 Emotions
 Culture 4. Self-Awareness- the process of
 Language understanding one’s own values, beliefs,
 Attention thoughts, feelings, attitudes, motivations,
 Surroundings prejudices, strengths and limitations.

Congruency of Messages Enhancing Communication

- Verbal and nonverbal communication must  Self-Disclosure
be congruent, or in agreement.  Caring
 Genuineness
Listening and Observing  Warmth
- Listening and observing are two of the most  Active Listening.
valuable skills a nurse can have.  Empathy (the capacity to understand
- These two skills are used to gather the another’s feelings)
subjective and objective data for the  Acceptance and respect
nursing assessment.
Communication Techniques
Active Listening  Clarifying/validating.
The process of hearing spoken words and  Asking open questions.
noting nonverbal behavior.  Using indirect statements.
Active listening takes energy and  Reflecting.
concentration.  Paraphrasing.
 Summarizing.
 Therapeutic Communication  Focusing.
 Silence.
  Passive - apologetic, weak, makes little eye
Guides in Therapeutic Communication contact, often fidgety.
Establish Rapport
How:  Aggressive - haughty, angry, demanding,
 Make it a habit to greet shows no concern for anyone else’s feelings
 Address the pt using his/ her name
 Start the conversation with active listening  Assertive - honest, direct, firm, makes eye
 Repeat contact, confident, respectful of others.
 Be consistent
 Be visible / offer self  Gestures
 Movements of the hands and arms.
Active Listening
 Create an environment that is foster  Nurses must be sensitive to cultural
 Physical Attention variances with regard to gestures.

5 Aspects  Meaning of Time

Square- face to face  In the U.S., great emphasis is placed on time
Open posture and schedules. Being on time is very
Lean Forward important.
Eye Contact  In other cultures, such emphasis is not
Relax placed on time.

 Barriers Communication Meaning of Space

Some barriers include: Human beings all observe rules around
 Closed questions. comfort zones—the distance observed
 False reassurance. between two people. Such comfort zones
 Judgmental responses. include:
 Defensive reflex. Intimate- touch to 18 inches
 Agreeing/Disagreeing or Approving/ Personal- 18 inches to 4 feet
Disapproving. Social- 4 feet to 12 feet
 Giving advice. Public- 12 feet or more
 Requesting an explanation.
 Cultural Values
 Changing the subject.
 A nurse should be familiar with the cultural
values of the people in the nurse’s region of
Blocks in Communication
employment.
 Attitude of the person
 A nurse needs to be aware of those times
- Needs, irritable/ negative, Authoritative and
when her values differ from the values of
Ignoring
the dominant culture.
 Language Barrier (Different Languages)
 Staff Shortage
 Political Correctness
 To be politically correct in communication
 Psychosocial Aspects of Communication
means to use language sensitive to those
 Style
who are different from oneself.
 Gestures.
 Meaning of time.  Nurse-Client Communication
 Meaning of space.  Almost every nurse-client interaction
 Cultural values. should involve therapeutic communication.
 Political correctness.  Nurse-client communication is influenced
by both the nurse and the client.
 Style
Three types of style:
Three Phases of Nurse-Client Communication  Group Communication (i.e. client-care
1. Introduction: Fairly short; expectations conferences)
clarified; mutual goals set
Written Communication
2. Working: Major portion of the interaction; Nurses’ communications are often written:
used to accomplish goals outlined in  On charts
introduction; feedback from client  Requisitions for x-rays and other tests and
essential. services
 Electronic communications, via computer
3. Termination: Nurse asks if client has  Telemedicine: the use of communications
questions; summarizing the topic is technology to transmit health information
another way to indicate closure. from one location to another.

Determinant Factors in Communication Self-Reflection

A nurse’s communication is affected by: Nurses often engage in internal dialogue:
 Past Experience  Positive self-talk: Saying positive thoughts
 State of Health aloud; thinking, saying and hearing positive
 Home Situation statements about yourself
 Workload  Negative self-talk: Self-destructive. Your
 Staff Relations self-image is lowered by your own criticism.
 Self-Awareness
Communicating with Yourself
Determinant Factors in Communication  Positive self-talk: Saying positive thoughts
A client’s communication is affected by: aloud; thinking, saying and hearing positive
 Social Factors statements about yourself
 Religion  Negative self-talk: Self-destructive. Your
 Family Situation self-image is lowered by your own criticism.
 Level of Consciousness
 Stage of Illness Therapeutic Communication Technique
 Visual, Hearing and Speech Ability  Acceptance
 Language Proficiency  Broad Opening
 Clarification & Validation
 Communication within the Health Care Team  Confrontation
 Providing care is a team effort.  Encouraging Comparison
 To ensure efficiency and effectiveness,  Exploring
effective communication is necessary.  Focusing
 This communication may be oral or written.  Formulating
 General Leads
 The Nurse’s Ways of Communication  Giving information
 Oral  Making observation
 Written  Offering Self
 Self-Reflection  Placing the even in time of sequence
 Presenting reality
Oral Communication  Reflecting
Nurses communicate within many different  Restating
relationships, each with their own rules.  Silence
 Nurse-Nurse  Suggesting Collaboration
 Nurse-Nursing Assistant  Summarizing
 Nurse-Student Nurse  Voicing out deeds
 Nurse-Physician
 Nurse-Other Health Professionals
Non-Therapeutic Communication
  Advising  DEVELOPMENT IS AFFECTED BY INNATE
 Agreeing BIOLOGICAL PROCESSES
 Belittling feeling of expression
 Challenging  HEREDITY PLAYS A VERY IMPORTANT ROLE
 Defending IN D&G
 Disagreeing
 Don’t worry statements
 Giving approval TRAITS
 Giving literal interpretation
 Interpreting  DOMINANT TRAITS
 Introducing an unrelated topic
 Making stereotype comm  RECESSIVE TRAITS
 Probing
 Reassuring
 Rejecting GENES
 Requesting an explanation
 Testing  MOST OF THE GENES ARE IN MENDELLIAN
PATTERN
“All behavior is caused and can be explained “

-Sigmund Freud MENDELLIAN PATTERN

 Gregor Mendel

THEORY o A monk and father of genetics

 ORGANIZED SET OF IDEAS THAT EXPLAINS

EVENTS
Mendelian law
 GROUP OF LOGICALLY RELATED
Law of Dominance 
STATEMENTS
 Dominant genes may mask or prevent the
expression of recessive genes
THEORIES
Law of Segregation
1. BIOLOGICAL THEORY
 Pair of gene is segregated during the
2. PSYCHOANALYTIC THEORY formation of gametes

3. PSYCHOSOCIAL THEORY  When an organism makes gametes, each

gamete receives just one gene copy, which
4. SOCIAL LEARNING THEORY is selected randomly.
5. PIAGET’S COGNITIVE DEVELOPMENT
 offspring receives one allele from each
THEORY
parent
6. VGOTSKY’S SOCIOCULTURAL THEORY
Law of Independent Assortment
7. ECOLOGICAL THEORY
 Independently formation of new genes

2. Psychoanalytic Theory
1. BIOLOGICAL THEORY
  Analysis of certain behavior  METHODS OF ATTEMPTING TO PROTECT
 Sigmund Freud (father of THE SELF AND COPE WITH THE BASIC
psychoanalysis) DRIVES OF EMOTIONALLY PAINFUL
 Viewed humans as Stimulus Driven who THOUGHTS, FEELINGS OR EVENTS.
respond to both internal and external  AUTOMATIC, INVOLUNTARY MECHANISMS
stimuli. OF THE MIND WHICH SERVE TO LOWER
 Believed that personality is formed ANXIETY, MAINTAIN EGO FUNCTIONING
during the 5th year of life AND PROJECT TO SELF-ESTEEM.
 “All behavior is caused and can be   Description Example
explained”
Defense  
Mechanism
STRUCTURES OF PERSONALITY
Repression Burying a painful You can’t
feeling or thought remember your
 ID from your awareness father’s funeral
though it may
 EGO  resurface in symbolic
form. 
 SUPEREGO
Denial Not accepting reality Drunk person
ID because it is too
painful
 PRESENT AT BIRTH
Regression Reverting to an older Stomping off to
 SERVES TO SATISFY NEEDS AND ACHIVE less mature way of another room or
handling stresses and pouting after a
IMMEDIATE GRATIFICATION
feelings fight
 PLEASURE PRINCIPLE Projection Attributing to your You get really mad
own unacceptable at your boyfriend
thoughts or feelings to but scream that
someone or something he’s the one mad
EGO else at you

 RATIONAL PART OF PERSONALITY AND Isolation Attempting to avoid a You run away
WORKS TO MAINTAIN HARMONY painful thought or from the crowd to
BETWEEN ID AND SUPEREGO feeling by objectifying avoid the
and emotionally shameful event
detaching oneself from
 REALITY PRINCIPLE
the feeling
 LOGICALLY ORIENTED IN TIME AND Displacement Channeling a feeling or When you get
DISTINGUISHES BETWEEN REALITY AND thought from its actual mad at your
UNREALITY source to something sister, you break
or someone else your drinking glass
by throwing it
against the wall.
SUPEREGO
Reaction Adopting beliefs, When you say
Formation attitudes and feeling you’re not angry
 PERFECTION PRINCIPLE
contrary to what you when you really
really believe are
 CONSCIENCE – CULTURALLY INFLUENCED
SENSE OF RIGHT OR WRONG

EGO DEFENSE MECHANISM

   Justifying one’s I always study Stage Year Focus Activity Accomplishment
behaviors and hard for the
Rationalization motivations by tests and I
Oral 0-18 Mouth Sucking Trust
substituting “good”, know a lot of Stage months

acceptable reason for people who

these real motivations cheat so it’s
not a big deal I Anal 18-3 Control Toilet Training Sense of
Stage years bladder & Accomplishment
cheated this bowel
time. training

Phallic 3-5 Genitals Discover the diff  

Altruism Handling your own pain After your wife Stage years between B and F

by helping others dies, you keep

yourself busy Latency 7-11 Suppressed Exploration Increase self-esteem
Stage years libido and confidence
by Stage of social
volunteering at Ego and SE communication
develops
the church

Genital  11 Strong Affair with Youth realizes that

Stage above interest to opposite sex sexual desires for
Sublimation Redirecting Intense rage opposite sex parents is taboo
unacceptable, instinctual redirected in
drives into personally the form of
and socially acceptable participation in
channels sports such as
Psychosexual Development
boxing or
football
 Satisfaction of each stage or if successfully
Suppression The effort to hide and You are completed will lead to a healthy
control unacceptable attracted to personality if not, FIXATION occur
thoughts or feelings someone but
say that you  Freud believed that
really don’t like
personality developed through a series of
the person at
all childhood stages in which pleasure-seeking
energies from the id became focused on
  Trying to reverse or You have certain erogenous areas
‘undo’ a thought or feelings of
Undoing feeling by performing an dislike for
action that signifies an someone so
opposite feeling than you buy them a 3. Psychosocial Theory
your original thought or gift
feeling  Erik Erikson

 Distinct psychosocial crisis or task must be

Identification Unconscious imitating of mastered or resolved by the Ego to advance
someone’s You enter a
hospital, got a
through various developmental stages;
desirable/undesirable
attributes as one owns. positive
experience and   failure- maladaptation
decides to
become a  Failure to resolve one or more crises is
nurse almost certain to encounter problem in the
succeeding stage or in the future.

Expressing emotional A woman

Conversion
conflicts through px sy complains of
headache I. Trust Vs Mistrust
following a visit
with a child  Infant to 18 months
 Giving basic needs.
Stages of Psychosexual Dev  Trust HOPE
  Mistrust- feeling of fear, sense that the  Inferiority- FEELING OF BEING NOT
world is inconsistent and GOOD ENOUGH, INCAPABLE TO DO
unpredictable. THINGS, ALWAYS DEPENDS ON OTHERS

II. Autonomy vs Shame and Doubt

V. Identity vs Role Confusion
 1-3 y/o
 10-20 y/o
 Toddlers
 STAGE OF RAPID CHANGE
 Beginning of realizing his or her own
 WANTS TO BE EXACTLY LIKE PEERS
independence
 Beginning of being BODY CONSCIOUS
 Helps in the ADL (basic task)
 Identity  FIDELITY
 Negativistic (Always say no)
 Fidelity, loyal to your plans and
 Learns to be careful because they know
aspirations.
that things broken cannot be fixed
 Role Confusion- INABILITY TO IDENTIFY
 Autonomy  WILL
WHAT HE/SHE REALLY WANT IN LIFE,
 Shame and Doubt- LOW SELF-
INABILITY TO ADJUST TO BODY
CONFIDENCE, POOR COMMUNICATION
CHANGES, LACK OF DIRECTION
SKILLS, DOUBT EVERYTHING HE DO,
LACK OF TRUST IN HIS OWN ABILITIES

VI. Intimacy vs Isolation

III. Initiative vs Guilt
 20-39 y/o
 3-5 y/o
 TIME OF EXPLORING RELATIONSHIP
 STARTING TO DO ADL ON THEIR OWN
 Sharing of success with someone you
 Initiates activities
love
 Stage of WHY
 Intimacy  LOVE
 Imaginary friends
 Isolation- Inability to form relationship,
 TOLERATE SHORT PEROIOD OF
afraid of commitment, always search
SEPANX
for new partner.
 Initiative  PURPOSE
  No matter how successful you are in
 Guilt- LOW SELF-CONFIDENCE, FEELING
work or in your chosen field, you are
OF GUILT IN EVERY CHOICES, SENSE OF
not COMPLETE until you are capable of
FAILURE, “TRY AGAIN” IS NOT ON HIS
INTIMACY
EGO

VII. Generativity vs Stagnation

IV. Industry vs Inferiority
 40-59 y/o
 6-10 y/o
 Share resources to the SOCIETY
 Power to do something
 TIME OF EXPLORING RELATIONSHIP
 INDUSTRIOUS
 Sharing with other people
 Hyper children
 Generativity  CARE
 Excellence in academics (school and
 Stagnation/ Self-
home)
Centered – Caring for no one, always
 Sense of accomplishment
get bored, not moving forward.
 Industry COMPETENCE
 VII. Ego Identity vs Despair

 60-death y/o / 65-death

 Reflects life with positivity
 ACCEPTS THAT MISTAKES IN THE PAST
CANNOT BE UNDONE and serves as a
lesson
 SENSE OF ACCOMPLISHMENT with few
regrets
 SATISFACTION IN EVERYTHING THEY
HAVE DONE
 Integrity  ACCEPTING DEATH AS
NATURAL PART OF LIFE
 Despair – Feeling of regrets, feeling
incomplete and life has been wasted,
not ready for death.

4. Cognitive Development Theory

 Concerned with the development of human

thought process
 Focus on the way children construct on
their own understanding of their
environment

Jean Piaget

 First psychologist to make a study of

cognitive development

 He believed that children think differently

than adults

 Intrigued with the reason children gave for

their wrong answer on the question that
require logical thinking

Jean Piaget’s Cognitive Learning Theory

  Theory that accounts for the steps and  This is the cognitive processes of fitting new
sequences of children’ intellectual information to the new one.
development

 Proposed that each stage serves as a

Accommodation
precursor to all succeeding stage so that
reasoning develop sequentially   Altering or modifying one’s existing
cognitive schemas or ideas as a result of
 Children construct what they already know
new information or new experiences
and what they discover in their
environment.

Equilibrium
Piaget’s Theory’s Goal  Helps explain how children are able to
move from one stage to the next.
 To explain the mechanism and processes by
which the infant, and then the child,
develops into an individual who can reason
and think using hypotheses 4 cognitive stages

2 major principle guides to intellectual growth and  Sensorimotor stage

development
 Preoperational stage
1)Organization
 Concrete Operation
2) Adaptation
 Formal Operation

Organization
1) Sensorimotor Stage
 Refers to the mind’s natural tendency to
 0-2 years old
organize information into related,
interconnected structures.  Limited Knowledge

 Skills and abilities utilize

Adaptation  Learns from senses
 Processes of viewed intellectual growth   Highlight Development: Object
Permanence – objects that exist are the
 For individuals to survive in an
objects that can be seen or heard even
environment, they must adapt to px and
though they are not in present.
mental stimuli. This happens through:

o Assimilation
2) Pre-operational Stage
o Adaptation
 3-7 years old

 Can differentiate a word or image from

what it is stand for and can name an
image or object not in site

Assimilation  Increasing adapt at using symbols 

  Child is EGOCENTRIC Logic

 Role playing  Inductive Logic – Specific Experience to

General Principle
 Egocentrism and Conservation
o E.g. child draws on wall because
 Egocentrism-choosing your own point of they only know the idea that pen
view (3 mountain task experiment) 3- can write on surfaces but never
dimension display know that pen should only be used
in paper not in wall

Conservation  but Difficulty Deductive Logic – general

principle to determine the outcome of
 Choosing the object that they think is full or specific even
large

 Based their choices in things that are larger

or looks bigger Classification

 Ability to sort objects or situation according

to their similar characteristics
Concept of Egocentrism and conservation

 Children are lack of understanding that

things and object can be looked different Elimination of Egocentrism
and change appearance while still  The child’s ability to view things from
maintaining the same properties another perspective

3) Concrete Operations Reversibility

 4-11 years old  Child’s awareness that actions can be
 Children gain a better understanding of reversed
mental operations  Being able to reverse the relationship
between mental categories

4 events in concrete operation

 Logic: Inductive Logic Seriation

 Classification  It refers to the ability to sort objects and

situation according to any characteristics.
 Elimination of Egocentrism ex;: least to greatest

 Reversibility  KNOWING OF SERIES

 Fading of conservation

4 events in Concrete Operation Stage 4). Formal Operations

  12- adulthood  Attention- pay attention / observing and
mimics.
 People develop the ability to think about
abstract concept skills such as deductive  Retention- Retaining of the information
logical thought and reasoning, systematic observed and interpreted.
planning.
 Motor Reproduction- Reproducing of
retained information.

Events in the Formal Operations  Reinforcement and Motivation- Doing of

action based on the feedback of other
 Logic: Deductive Logic
people.
 Abstract Thought

 Problem Solving 7. Ecological Theory

 Urie Bronfenbenner
5. Vygotsky’s Socio-Cultural Theory
 Environment or place where you belong
 Lev Vygotsky (Russian Pyschologist) affects the development

 Sociocultural action in the development of 1. Microsystem- small group of people that

cognition affects our dev’t. (Parents)

 Social interactions play a fundamental role 2. Mesosytem- People outside our home that
in the process of cognitive development affects us. (Families outside our home)

 Child follow the adult’s example gradually 3. Exosystem- Community/ barangay that
develop the ability to do certain tasks w/o affects us.
his or help 4. Macrosystem- larger community such as
 Cognitive – way of thinking municipality, province, national
government.

5. Chronosystem- experiences from past/

6. Bandura’s Social Learning Theory present

 Albert Bandura

 Learning doesn’t require reinforcement

 Individual can learn by observing other

people

 Person’s behaviour is influenced by the

environment

4 process of learning for this theory

Piaget- has sequence. Child should learn something
first to learn.

Vygostsky- Culture and environment has a huge

impact in the person’s development.

Bandura- Individual can learn from observing and

the behavior is influenced by the environment