Psychosocial Integrity / Topic 1

Make sure to:

  • Assess the environment of each client.
  • Evaluate the communication needs of clients.
  • Implement therapeutic communication in clinical practice.

Clients entering healthcare settings may feel overwhelmed due to the fast pace and the abundance of activities and communications in the environment. Nurses and other healthcare team members can support these clients by creating a therapeutic environment and facilitating therapeutic communication.

In this learning experience, learners will gain knowledge about establishing a therapeutic environment and communication, focusing on assessing their client's environment, understanding their communication needs, and providing therapeutic communication.

1.1 Assessment of Clients' Environment

Nurses must assess their clients' environment for hazards that could adversely impact their physical and psychological safety and well-being (Burke, 2023). According to Burke (2023), it is important to:

  • Identify the factors that may influence client's recovery.
    • Considering support systems such as family and friends.
    • Utilizing community resources like professional and peer support groups that can offer psychological assistance to clients. This includes groups such as Alcoholics Anonymous and Narcotics Anonymous, as well as meetings for individuals with similar conditions, such as depression.
  • Using assessment findings to establish a therapeutic environment.
    • Strategically assigning client rooms, including:
      • Placing suicidal clients close to the nurses' station for frequent and easy observation.
      • Avoiding rooming clients with negative behaviors together with those that may trigger such behaviors.
  • Identifying clients with emotional/behavioral issues and providing a therapeutic milieu where the nurse consistently:
    • Establishes, provides, and maintains a safe and supportive therapeutic environment.
    • Enforces rules for all clients.
    • Informs clients about expectations concerning their behaviors.

1.2 Assessment of Communication Needs of Clients

Nurses and their clients are in constant communication, and it is important for this communication to be effective. When assessing their clients' communication needs, nurses must recognize that clients communicate in various ways:

  • Nonverbally, through gestures and body language. For example, moving their head from side to side to indicate no and up and down for yes (Burke, 2024). Nonverbal communication is often the most accurate reflection of one's attitude (Kaplan Nursing, 2023).  
  • Verbally, using the words they speak (Burke, 2024).
  • In writing, expressing themselves through written words (Burke, 2024).

Numerous factors can hinder effective communication. Burke (2024) provides insight into the specific needs of clients and strategies to foster effective communication between nurses and their clients. These considerations include:

  • Culture significantly influences how clients perceive nonverbal communication. In some cultures, gestures such as touch, close proximity, and eye contact may be seen as unacceptable, while in others, it is acceptable and even welcomed.
  • Medical treatments, such as intubation, can impede a client's ability to communicate verbally. In such cases, nurses should encourage and facilitate nonverbal and/or written forms of communication.  Additionally, communication with sedated clients can be challenging.
  • The client's level of consciousness, which can range from a complete inability to receive any form of communication to full responsiveness, should be considered. Nursing care plans must be adapted accordingly. For example, using touching to signify presence and care for unresponsive clients and employing pictures for those who struggle with verbal communication.
  • In situations where the client's primary language is not English, nurses should secure the services of an interpreter. For deaf clients, an American Sign Language interpreter is recommended, and for blind clients, the use of Braille should be considered.
  • Nurses should also consider the client's developmental stage and age, tailoring healthcare to be developmentally and age appropriate.
  • Clients' emotional state and stress levels such as anxiety, confusion, fear, and distress, can obstruct effective communication and should be alleviated or managed.
  • Individual values, beliefs, perspectives, and perceptions can lead clients to interpret messages in a biased way. Nurses can mitigate this bias by clarifying information. For instance, a client may frown due to pain or distaste, not necessarily dissatisfaction.
    • The nurse-client relationship should empower clients, ensuring they understand their role in deciding upon their care. This can be achieved by:
      • Establishing trust.
      • Facing the client during communications.
      • Staying at eye level with the client to demonstrate equality.

1.3 Therapeutic Communication

Nurses employ therapeutic communication to comprehend and foster a positive relationship with their clients (Kaplan Nursing, 2023). Therapeutic communication should be:

  • Planned.
  • Directed towards the client.
  • Oriented towards specific goals.

Nurses can utilize the therapeutic communication techniques described by Burke (2024) with their clients:

  • Silence: Allowing time for both the nurse and the client to reflect on what has been said and to contemplate their responses. Nurses should maintain silence for an appropriate period, enabling clients to process the discussion and then express their beliefs, opinions, and feelings.
  • Focusing: Encouraging clients to remain focused on their healthcare needs. This may require the nurse to gently steer the conversation back when clients veer off into personal or unrelated topics.
  • Clarification: Nurses should validate and clarify information received from clients. This ensures that the messages are accurate, unbiased, and comprehensive. Specific clarification techniques include:
    • Exploring – Encouraging clients to provide more details about their problems or issues.
    • Paraphrasing – The nurse rephrases the client's statement in their own words to confirm understanding. For instance, if a client says, "I am too tired to even think", the nurse might respond, "Do you mean you're too tired now to continue with this education?"
    • Reflecting – The nurse reflects what they perceive the client's words imply about their feelings, enabling the client to articulate these feelings. For example, if a client seems angry and upset, the nurse may say, "You seem a little angry today. Would you like to talk about it?"
    • Restating – The nurse repeats what the client has communicated to confirm and validate their understanding.
  • Summarizing: This involves nurses stating the key points discussed and the decision reached. The conversation might begin with phrases like, During our discussion today…
  • Offering self: This technique allows the nurse to offer their presence and time to assist their clients in meeting their needs.
  • Attentive, active listening: Here, the nurse actively hears, processes, and fully understands their client's verbal, nonverbal, and written communication.
  • Providing leads to the client: This method empowers clients to either continue discussing a current issue or initiate a conversation about a new topic.
  • Using open-ended questions: This approach is necessary when the nurse seeks more than a simple yes or no answers. Such questions enable clients to express themselves more openly and freely.

Consistently strive to foster therapeutic communications with all clients, continually encouraging them to express their thoughts, feelings, and ideas. Avoid the following:

  • Challenging clients.
  • Probing unnecessarily.
  • Changing the subject abruptly.
  • Being defensive.
  • Offering false reassurances.
  • Disagreeing in a way that invalidates their experience.
  • Judging clients.
  • Rejecting and minimizing their thoughts and feelings.
  • Stereotyping clients.

Upon conclusion of this learning experience, the learner will acquire a comprehensive understanding of the importance of creating a therapeutic environment and communication for their clients. The objectives include aiding in the successful completion of the NCLEX examination and enhancing performance in the workplace.

After reviewing the resources, identify the specific areas for improvement and concentrate on them.

  • Burke, A. (2023, December 13). The Therapeutic Environment: NCLEX-RN. https://www.registerednursing.org/nclex/therapeutic-environment/
  • Burke, A. (2024, January 20). Therapeutic Communication: NCLEX-RN. https://www.registerednursing.org/nclex/therapeutic-communication/
  • Kaplan Nursing. (2023). Next Generation NCLEX-RN Prep 2023-2024: Practice Test + Proven Strategies (9th ed.). Kaplan Test Prep.

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