Therapeutic communication

Communication process that people use to

exchange information.
Verbal communication consists of words a
person uses to speak to one or more listeners
Content literal words that the person speaks.
Context the environment in which the
communication occurs and can include the time
and physical, social, emotional and cultural
environment.
Nonverbal communication the behavior that
accompanies verbal content such as body
language, eye contact, facial expression, tone of
voice, etc.
Process denotes all nonverbal messages that the
speaker uses to give meaning and context to the
message.
Congruent message conveyed when content
and process agree.
Incongruent message the content and message
disagree.
Therapeutic communication an interpersonal
interaction between the nurse and the client during
which the nurse focuses on the clients specific
needs to promote an effective exchange of
information.
Goals of Therapeutic Communication:
1. Establish a nurse- client relationship.
. !dentify the most important client concern at
that moment.
". #ssess the client$s perception of the
problem as it unfolds.
%. &acilitate the client$s expression of
emotions.
'. (each the client and family necessary self-
care skills.
). *ecogni+e the client$s needs.
,. !mplement interventions designed to
address the client$s needs.
-. .uide the client toward identifying plan of
action to a satisfying and socially
acceptable resolution.
Privacy and Respecting Boundaries
/rivacy is desirable but not always possible.
PROXEMICS the study of distance +ones
between people during communication.
(herapeutic communication interaction is most
comfortable when the nurse and the client are "
to ) feet apart.
Touch
#lthough touch can be comforting and
therapeutic, ii is an invasion of intimate or
personal space. 0ome clients with mental
illness have difficulty understanding the
concept of personal boundaries or when touch
is or is not appropriate.
1hen nurse is going to touch the client while
performing nursing care, he or she must
verbally prepare the client before starting the
procedure.
Active Listening and bservation
ACTIVE LISTENING refraining from other internal
mental activities and concentrating exclusively on
what the client says.
ACTIVE OBSERVATION watching the speakers
non verbal actions as he or she communicates.
#ctive listening and observation help the nurse to2
*ecogni+e the issue that is most important to
the client.
3now what further 4uestion to ask the client.
!nterpret and respond to the message
ob5ectively.
V!RBAL C""#NICATIN $%ILL$
6sing 7oncrete 8essages
1hen speaking to the client the nurse should
always use words that are as clear as possible
to that the client can understand the message.
!t is important for accurate information
exchange.
6se (herapeutic 7ommunication (echni4ues
#voiding 9ontherapeutic communication
!nterpreting 0ignals and 7ues
CUES verbal or nonverbal messages that signal
key words or issues for the client.
7ue words introduced by the client can help the
nurse to know what to ask next or how to
respond to the client.
OVERT CUES direct statements of intent.
COVERT CUES vague or indirect messages that
need interpretation and exploration.
NNV!RBAL C""#NICATIN $%ILL$
- 9onverbal communication is the behavior a
person exhibits while delivering verbal content.
- !t involves the unconscious mind acting out
emotions related to the verbal content, the
situation, the environment, and the relationship
between the speaker and the listener.
&acial Expression
&acial movements connect with words to
illustrate the meaning: this connection
demonstrates the speakers internal dialogue.
E;/*E00!<E portrays the persons moment-
by-moment thoughts, feelings and needs.
!8/#00!<E fro+en into emotionless deadpan
expression.
7=9&60!9. expression is one that is the
opposite of what the person wants to convey.
>ody ?anguage
7losed body position
@and gestures
<ocal 7ues
(ransmitted along with the content2 voice
volume, tone, pitch, intensity, emphasis,
pauses and speed.
Eye 7ontact
?ooking into the other persons eye during
communication is used to assess the other
person and the environment and to indicate
whose turn it to speak: it increases during
listening but decreases while speaking.
0ilence
!t may indicate that the client is depressed and
struggling to find energy to talk.
8ay indicate that the client id thoughtfully
considering the 4uestion before responding.
9ot paying attention.
#llow the client sufficient time to response.
Therapeutic Techni&ue
'( ))ering $el)
8aking self-available and showing interest
and concern.
A! will walk with youB
*( Active listening
/aying close attention to what the patient is
saying by observing both verbal and non-
verbal cues.
8aintaining eye contact and making verbal
remarks to clarify and encourage further
communication.
+( !xploring
A(ell me more about your sonB
,( -iving broad openings
1hat do you want to talk about todayC
.( $ilence
/lanned absence of verbal remarks to
allow patient and nurse to think over what
is being discussed and to say more.
/( $tating the observed
verbali+ing what is observed in the patient
to, for validation and to encourage
discussion
ADou sound angryB
0( !ncouraging comparisons
#sking to describe similarities and
differences among feelings, behaviors, and
events.
A7an you tell me what makes you more
comfortable, working by yourself or working
as a member of a teamCB
1( Identi)ying themes
#sking to identify recurring thoughts,
feelings, and behaviors.
A1hen do you always feel the need to
check the locks and doorsCB
2( $ummari3ing
*eviewing the main points of discussions
and making appropriate conclusions.
AEuring this meeting, we discussed about
what you will do when you feel the urge to
hurt yourself again and this includeFB
'4( Placing the event in time or se&uence
#sking for relationship among events.
A1hen do you begin to experience this
ticksC >efore or after you entered grade
schoolCB
''( Voicing doubt
<oicing uncertainty about the reality of
patients statements, perceptions and
conclusions.
A! find it hard to believeFB
'*( !ncouraging descriptions o) perceptions
#sking the patients to describe feelings,
perceptions and views of their situations.
A1hat are these voices telling you to doCB
'+( Presenting reality or con)ronting
0tating what is real and what is not without
arguing with the patient.
A! know you hear these voices but ! do not
hear themB.
A! am ?hynnelli, your nurse, and this is a
hospital and not a beach resort.
',( $ee5ing clari)ication
#sking patient to restate, elaborate, or give
examples of ideas or feelings to seek
clarification of what is unclear.
A! am not familiar with your work, can you
describe it further for meB.
A! dont think ! understand what you are
sayingB.
'.( Verbali3ing the implied
*ephrasing patients words to highlight an
underlying message to clarify statements.
/atient2 ! wont be bothering you anymore
soon.
9urse2 #re you thinking of killing yourselfC
'/( Re)lecting
(hrowing back the patients statement in a
form of 4uestion helps the patient identify
feelings.
/atient2 ! think ! should leave now.
9urse2 Eo you think you should leave nowC
'0( Restating
*epeating the exact words of patients to
remind them of what they said and to let
them know they are heard.
/atient2 ! cant sleep. ! stay awake all night.
9urse2 Dou cant sleep at nightC
'1( -eneral leads
6sing neutral expressions to encourage
patients to continue talking.
A.o onFB
ADou were sayingFB
'2( As5ing &uestion
6sing open-ended 4uestions to achieve
relevance and depth in discussion.
A@ow did you feel when the doctor told you
that you are ready for discharge soonCB
*4( !mpathy
*ecogni+ing and acknowledging patients
feelings.
A!ts hard to begin to live alone when you
have been married for more than thirty
yearsB.
*'( 6ocusing
/ursuing a topic until its meaning or
importance is clear.
A?et us talk more about your best friend in
collegeB
ADou were sayingFB
**( Interpreting
/roviding a view of the meaning or
importance of something.
/atient2 ! always take this towel wherever !
go.
9urse2 (hat towel must always be with you.
*+( !ncouraging evaluation
#sking for patients views of the meaning or
importance of something.
A1hat do you think led the court to commit
you hereCB
A7an you tell me the reasons you dont
want to be dischargedC
*,( $uggesting collaboration
=ffering to help patients solve problems.
A/erhaps you can discuss this with your
children so they will know how you feel and
what you wantB.
*.( !ncouraging goal setting
#sking patient to decide on the type of
change needed.
A1hat do you think about the things you
have to change in yourselfCB
*/( !ncouraging )ormulation o) a plan o) action
/robing for step by step actions that will be
needed.
A!f you decide to leave home when your
husband beat you again what will you do
nextCB
*0( !ncouraging decisions
#sking patients to make a choice among
options.
A.iven all these choices, what would you
prefer to doCB
*1( !ncouraging consideration o) options
#sking patients to consider the pros and
cons of possible options.
A@ave you thought of the possible effects of
your decision to you and your familyCB
*2( -iving in)ormation
/roviding information that will help patients
make better choices.
A9obody deserves to be beaten and there
are people who can help and places to go
when you do not feel safe at home
anymoreB.
+4( Limit setting
Eiscouraging nonproductive feelings and
behaviors, and encouraging productive
ones.
A/lease stop now. !f you dont, ! will ask you
to leave the group and go to your room.
+'( $upportive con)rontation
#cknowledging the difficulty in changing,
but pushing for action.
A! understand. Dou feel re5ected when your
children sent you here but if you look at this
wayFB
+*( Role playing
/racticing behaviors for specific situations,
both the nurse and patient play particular
role.
A!ll play your mother, tell me exactly what
would you say when we meet on 0undayB.
++( Rehearsing
#sking the patient for a verbal description
of what will be said or done in a particular
situation.
A0upposing you meet these people again,
how would you respond to them when they
ask you to 5oin them for a drinkCB.
+,( 6eedbac5
/ointing out specific behaviors and giving
impressions of reactions.
A! see you combed your hair todayB.
+.( !ncouraging evaluation
#sking patients to evaluate their actions
and their outcomes.
A1hat did you feel after participating in the
group therapyCB.
+/( Rein)orcement
.iving feedback on positive behaviors.
AEveryone was able to give their options
when we talked one by one and each of
waited patiently for our turn to speakB.
Avoid pitfalls:
1. .iving advise
. (alking about your self
". (elling client is wrong
%. Entering into hallucinations and delusions
of client
'. &alse reassurance
). 7lichG
,. .iving approval
-. #sking 1@DC
H. 7hanging sub5ect
1I. Eefending doctors and other health team
members.