Your introduction will include the use of your full name and the client’s formal name. After the initial introduction, it is appropriate to ask the client what name he or she would like you to use. Many of us have had the experience of having our names mispronounced or shortened in ways that left us feeling vaguely and unnecessarily uncomfortable. Endearments such as “sweetie” or “mamma” are never appropriate. Your nonverbal behavior must convey respect and warmth. Position yourself at eye level rather than standing over the client as he or she lies in bed or sits in a wheelchair. Lean slightly toward the client to convey interest. Maintaining eye contact while staying at an appropriate social distance (4 feet away) is important in beginning a successful relationship.

Active listening is a form of therapeutic listening that helps the client clearly convey what he or she is trying to say. It involves paraphrasing the client’s words to clarify whether or not you have caught the client’s intended meaning. You must suspend your thoughts and attend exclusively to the nonverbal behavior and the words of the other person. This is not easy and requires practice. Your goal is to understand rather than judge or defend against. For some, it will require great effort to resist responding with a suggestion of what to do or with an argument. One word you will want to avoid at such times is “but.”

Active listening is made up of three different processes:¹

These skills take practice, as does resisting the impulse to fix the problem. In this case, the client may begin to feel some relief just because he or she has been heard and may begin to problem solve on his or her own: “I will call my supervisor and explain that I haven’t had a chance to talk to the doctor yet. I don’t really want to leave if there is something really wrong.”

We communicate more with nonverbal behavior than we do with words. Our nonverbal behavior conveys how we feel regardless of what we say. The nurse’s nonverbal communication can either facilitate or hinder the quality of the interview. Key nonverbal elements of a helping interview include use of space (eliminate physical barriers such as a desk between you and the client), time (minimize interruptions), appropriate posture (avoiding rigid posture, slouching, or defiant gestures), voice inflection (appropriate speed and volume; warmth and genuine interest conveyed versus flatness or excessive use of “you knows”), and eliminating distracting body movements (twitching, shaking foot, tapping pencil).

Congruence is a term that indicates that the verbal and nonverbal messages match.² For example, congruence is present when the nurse admits that he or she is frustrated or irritated rather than denying those feelings. If the nurse denies feelings, nonverbal responses such as muscle tension and facial expression will communicate the feeling to the client anyway and create confusion. Incongruence appears dishonest or “not ringing true.” How often have we been caught in incongruence when someone asks for a compliment: “Well, do you like my new haircut or not?” “Well yes, it’s okay I guess.” What was felt was less than okay but no one likes to appear rude. When a person is congruent, he or she appears to be open, honest, genuine, and authentic. Nonverbal cues and tone of voice are consistent with the words spoken.

Congruence requires self-awareness. Before speaking, you must consider both feelings and thoughts and reconcile conflicts such as wanting to not be hurtful, yet wanting to be honest. A congruent response to the requested compliment might be: “You know, I noticed you had a new haircut, but I really liked it the old way.” With this response, the person realizes that you value honesty and are willing to be honest but can avoid being rude. The message “rings true” and you feel better. More important, the person knows you will resist trying to please others and disregarding your own feelings.

Congruence is best conveyed when it is communicated with sensitivity. It should never be used as a rationalization for insensitive and rude honesty.

Many of us are rather unaware of our day-to-day communication style and are surprised when someone misunderstands the message we have tried to convey. It is difficult to come outside of ourselves and notice how we interact with others. Some of us have been given direct feedback by our friends about our communication. Statements such as, “I love the way you listen carefully to what I say and wait until I’m finished before you respond,” vs, “I wish you’d hear me out instead of mentally practicing a quick comeback!” give us clear information about how we are doing as we communicate in that moment.

When strong emotions are communicated, the message may be unclear because the client (or nurse) is upset and unable to clearly identify what the heart of the problem is and how to best go about solving it. To be effective, you must be aware of your emotional reactions and avoid the use of emotion-laden communication (even when you feel personally attacked).

Emotion-laden exchanges are cluttered with intense feelings, derogatory remarks, apologies, and so on. To sort out the problem, special listening skills are needed to defuse the emotion and get at the problem. Resist the desire to respond (unhelpfully) to correct the problem right away to get rid of the client’s (or your own) anxiety, anger, or conflict. Too often, we respond by giving quick advice or offering a defensive reply. Instead, use active listening skills.

Situations such as placing a loved one in long-term care involve feelings of loss, vulnerability, and fear. Family members must give over control to strangers, often in institutions that seem strange, impersonal, and frightening with cultures very different from their own. At the root of every emotional outburst is a problem. What, exactly, is the problem in this case example, and whose problem is it? Mrs. Garcia would say that the problem is that her mother is not being treated well. Therefore, the nursing home and food are the problems. The nurse might say that the problem is that Mrs. Garcia is feeling helpless about her mother’s illness and lashed out in frustration. Both are correct from their own way of seeing the world. If the nurse maintains that he or she is right, it will not solve the problem. To resolve the problem, it is the nurse’s responsibility to take the client’s view (in this case, Mrs. Garcia, as Mrs. Mendel’s closest relative, is the client). The nurse can resolve this uncomfortable situation and at the same time avoid taking blame for the situation by active listening and the use of “I” messages.

When an individual feels distressed and wants to communicate to another person that he or she is upset, clear communication is facilitated with “I” messages. “I” messages (“I think” or “I feel,” rather than the commonly used editorial “they,” or “you,” or “everyone”) are most effective for resolving problems.³

Many people have a tendency to blame when they feel uncomfortable. An example in which the nurse blames the client might be: “You keep making suggestive remarks. I’m not going to be able to help you if you keep talking that way.” In this case, whose problem is it? If I am upset, the problem is mine. The following response using an “I” message is more likely to resolve the problem: “I’m feeling very frustrated. I’m trying to help you learn about your diabetes and I’m feeling uncomfortable with the things you are saying. Let’s talk about this.”