Facilitate Change

Compassionate Relationships

Do you wonder how you can communicate with someone who is raising his voice? Do you wonder what is going on for someone who is swearing at you? Do you wonder how you can create peace and harmony between you and these people?

Marshall Rosenberg, www.cnvc.org, the founder of Non-Violent Communication, states that everything we say or do is to meet a need. For thousands of years we have been taught a communication language that alienates us from others rather than helping us to connect with others in a compassionate, non-judgmental way. Every time we blame, label, or diagnosis someone, we are alienating others from us. Instead, we can empathize with others by guessing their feelings and needs, which can invoke compassion in our selves and others.

Marshall Rosenberg presents a four-part communication process that is easy to learn. The four components are: observation, feelings, needs and requests. Instead of judging, we focus on facts or observation; what can a camera see? Instead of thoughts, we look at what feelings we are experiencing in the moment. We focus on what would help us feel more alive, what are our needs? We can empower ourselves by making requests of ourselves and others.

For example, when someone is raising his voice, we can choose to express ourselves or have empathy for him. For example, “When I hear you raising your voice, I feel nervous and have a need for peace. Would you be willing to speak more quietly?”
Or, “Are you feeling upset because you have a need for understanding, would you like me to get someone who can speak to you in your language?” Two other choices that we have in this situation that are not helpful and alienate us from the other and from ourselves, is to either blame him or blame yourself: “He is so impatient!” or “I have no patience!” On the other hand, you can have compassion for yourself or compassion for the other person: “When I hear him raising his voice, I feel irritated as I have a need for understanding.” Or, “Are you feeling upset because you would like understanding and acceptance?”

When you have compassion for yourself, you are able to connect with others. When you have compassion for other people, they may be inclined to change their behavior as they become motivated to contribute to your well-being because they feel heard and understood. Moreover, they feel that they matter.

How is Marshall Rosenberg’s communication process helpful in health care settings? We can help clients to become conscious of their feelings and needs and henceforth, help them to get their needs met. We can also help them to come to peace about needs that are not met. Working as a psychiatric nurse, I have had many positive outcomes by empathizing with my clients. Non-violent communication can help in various ways in the health care setting. For example:

1. Least Restraint Policy. We can prevent people from getting into restraints, as hospitals are moving towards least restraint policies. For example, a nurse in the States working in forensics, Donna Reimer, was able to reduce the number of clients going into seclusion and restraints by over 75% in 2 years by training staff and clients to use non-violent communication. Another nurse trainer of non-violent communication in the United States, Melanie Sears, told me that whenever she worked with patients, they were not in restraints but on days when she wasn’t working, some of these same patients would be in restraints. A patient once asked me to put him in restraints. We talked about what needs would be met by him going into restraints (i.e. a need to be heard, and understood) and I told him mine (i.e. a peaceful working relationship) and he did not go into restraints when he was working with me, but did go into them on other days.

2. Connection with clients. When clients feel they have been understood and heard, they feel happy and you enjoy a peaceful, working relationship with them. A client wanted to go Italy to drive cars and he was brought back to the hospital. It was his belief he could race cars in Italy, but he had no experience in this. So I connected with him by saying, “I guess you are sad that you are not able to pursue your dream.” After that, I could see from his facial expression that he was happy to see me whenever I came to work.

3. Non-compliance with medications. Sometimes, patients do not want to take medications and by empathizing with them, they are more likely to take them. A patient said to me, “Why do I have to take this medication,” and I said, “I want to contribute to your well-being; I want to see you getting better.” After hearing this, she took the medications.

4. Decrease the number of use of PRN medications given to chemically restrain patients if they feel agitated. A patient told me that he felt paranoid, and I asked him if he was feeling scared and needed to feel safe, and he said yes. Then we talked some more and I understood his need to be seen for who he was, that he would not harm anyone when he went out. Earlier, he had read in the newspaper, that an innocent boy was killed by a black man and he feared that when he was outside, people would stereotype him and think that he who would harm others, as he was black himself. He felt relieved to be understood and when I asked if he wanted medications for his anxiety, he said, “No, Miss. The talking helped.”

These are some examples of how empathizing with clients can help us to meet their needs and our needs. Non-violent communication is a powerful communication tool that can help us to contribute to our well-being and that of others.

If you are interested in training in this area or have questions, please e-mail, Bhupinder Gill, M.Sc., R.N. at: Bhupindergll@yahoo.com