Therapeutic Communication

Communication Essentials

• Communication encompasses the exchange of information.
• Verbal communication involves the content of literal words and the context of the environment and circumstances.
• Nonverbal communication uses messages to give meaning and context.
• The messages can be congruent (consistent) or incongruent (inconsistent).

Therapeutic Communication

• Prioritizes interpersonal interactions by concentrating on the client’s needs.
• Privacy is essential.
• Skilled therapeutic communication helps nurses understand and empathize with the client’s experiences.
• Therapeutic communication is needed to meet client care standards effectively.
• The goals include establishing a therapeutic nurse-client relationship.
• Identifying the client's main concerns to assess perceptions is important.
• Facilitating the expression of emotions.
• Teaching self-care skills.
• Recognizing needs
• Implementing interventions.
• Therapeutic communication guides clients toward viable solutions.
• Proxemics is the study of distance zones during communication.
• Intimate distance: 0-18 inches.
• Personal distance: 18-36 inches.
• Social distance: 4-12 feet.
• Public distance: 12-25 feet.
• 3 to 6 feet apart is often the most comfortable for therapeutic communication.
• Request permission before invading personal or intimate space.
• Social distancing is recommended to prevent virus spread, like COVID-19.
• Social distancing includes staying home and away from others.
• Physical distancing includes staying at least 6 ft away from others.
• Distancing affects zones and touch.

Touch types

• Functional-professional
• Social-polite
• Friendship-warmth
• Love-intimacy
• Sexual-arousal
• Comforting when welcome and permitted and can also be an invasion of space.
• Nurses need to evaluate touch based on preferences, history, and needs.
• Nurses might find touch supportive, but clients might not.
• Active listening involves concentrating exclusively on what the patient says.
• Active observation involves watching nonverbal actions as the speaker communicates.
• Recognize the most important issue.
• Know what questions to ask.
• You should use therapeutic communication techniques.
• Try to prevent jumping to conclusions.
• Objectively respond to messages.

Verbal Communication Skills

• Concrete messages are needed, instead of abstract.
• Techniques will involve: Exploring, focusing, restating, and reflecting.
• Some techniques promote in depth discussion of feelings or concerns.
• Other verbal techniques will focus on clarifying what is being said.
• You can give feedback by making an observation or presenting reality.

Abstract and Concrete examples

• Abstract: "Get the stuff from him."
• Concrete: "J will be home at 5 p.m., and you can pick up your clothes at that time."
• Abstract: "Your clinical performance has to improve."
• Concrete: "To administer meds tomorrow, you'll have to calculate dosages correctly by the end of the day."
• Avoidance of nontherapeutic techniques is key
• "Why" questions should not be asked.
• Avoid: Advising, belittling, challenging, probing, and reassuring.
• Interpretation of signals or cues can be Overt statements - "I want to die."
• Covert statements: “Nothing can help me.”

Interpreting Cues

• Themes, Metaphors and Proverbs
• Theme of sadness:
• Patient: “Oh, hi, nurse - face is sad; eyes look teary; voice is low, with little inflection"
• Nurse: “You seem sad today, A.M.”
• Theme of loss of control:
• Client: “I had a fender bender this morning. I'm OK. I lost my wallet, and I have to go to the bank to cover a check I wrote last night. I can't get in contact with my husband at work. I don't know where to start.”
• Nurse: “I sense you feel out of control." (translating into feelings)
• Client: “My son's bedroom looks like a bomb went off.”
• Nurse: “You're saying your son is not very neat.”
• Client: “My mind is like mashed potatoes.”
• Nurse: “I sense you find it difficult to put thoughts together".
• Client: “People who live in glass houses shouldn't throw stones.”"
• Nurse: "Who do you believe is criticizing you but actually has similar problems.
• Nonverbal communication accuracy is often better then verbal communication when the two are incongruent.
• People can readily change what they say but are less likely to be able to control nonverbal communication.
• Body language includes closed and open positions.
• Nonverbal communication also involves:
• Vocal cues
• Eye contact
• Silence

Initial Session

• Begining a therapeutic communication session consists of introduction and relationship establishment
• Learning how the client prefers to be addressed can be useful
• Identifying their major concern should be a priority
• Nondirective roles involve broad openings, more open ended questions
• Directive roles are more direct with yes-or-no questions; often for clients with suicidal thoughts, in crisis, or dealing with reality
• When doing an introduction, include recognition combined with introducing yourself, and setting limits of contract
• Example nurse statement: “Hello, V.W. My name is J., and I'll be your nurse today. I'm here from 7 a.m. to 3:30 p.m. Right now I have a few minutes, and I see you are dressed and ready for the day. I would like to spend some time talking with you if this is convenient.”
• For a Non-directive Role responses are usually very accepting
• Nurses use general lead responses in these scenarios

Therapeutic Communication techniques

• Asking for clarification: "What was it that you saw coming?
• Guideline for client in problem-solving and change.
• Helping the client explore possibilities can be useful
• Making sure the client's participation is key aspect
• Importantly, you should never insert personal beliefs or give advice ever.
• Assertive Communication
• Use techniques such as; expression of positive and negative feelings/ideas in an open, honest, direct way
• Be Calm, specific, factual with any statements
• Possible responses can include: aggressive, passive-aggressive, passive or assertive
• In Using silence Technique the goal should be to encourage the patient to organize thoughts and put them into words, allow time to think, understand feelings and events
• When Accepting, the goal shoul be conveying an attitude of understanding and willingness to interact such as through eye contact or nodding.
• Acknowledgeing and indicating awareness is better when complimenting.
• This shows the nurse's judgment.
• When Offering yourself, show Willingness to spend time with the patient and show interest on an unconditional basis
• Use techniques such as, "Hello, Mr and Mrs. J. I notice that you made a ceramic ash tray in OT.”
• broad openings allow the patient to direct the focus of the interaction: example "What would you like to talk about today?"
• General leads such as "Yes, I see" offer the patient patient encouragement to continue with minimal input.
• Placing the event in time or sequence can also be used: example "when did this happen"
• Verbalizing observations about a patient’s behavior or appearance can lead to the patient to develop awareness of how they are perceived by others
• Asking the patient to verbalize his or her perceptions
• "Was this incident similar to anything else that happened to you before?"

Restating, Reflecting and Focusing

• Restating helps patient assess if what was says was understood example: Patient: "I can't study. My mind keeps wandering." Nurse: "You have trouble concentrating.”
• Reflecting involves refered to what was said for the patient to actively engage in problem-solving rather than seeking the nurse:'s advice
• Focusing involves targeting what was said earlier and encouraging specific discussion about a relevant issue.
• Exploring is also important to explore the patients feelings.

Clarification And Reality

• Seeking and understanding statements and searching for understanding facilitates the nurses and patients expereinces.
• When the client is having a misperception of the environment, the nurse defines reality by communicating there view of the situation without challenging the client:'s perceptions.
• Expressing uncertainty about the legitimacy of the patient’s perceptions.
• Putting into words what the patient has only implied or said indirectly is a technique that can be helpful with patients experiencing impaired verbal communication.

Formulation And Actions

• When the patient has difficulty identifying feelings or feelings are expressed indirectly, the nurse tries to “desymbolize” what has been said
• Encouraging the client to establish a plan for behavior change promotes developing better coping skills.

Dont Say

• Refusing to considering someone may cause the client:'s rejection and abandonment as False reassurance indicates
• The result of a situation knows out ahead by the nurse and diminishes the client:s expressed concern

Non-Therapeutic Communication

• Approving or disapproving and and implies the nurse as a rule implying judgement
• By suggesting thoughts it means that your're either right or wrong implying what is right
• By giving information implies it needs to be followed by all patients
• Probing the client's issues causes further tension
• When a therapist is demeaning it causes the client to demean and feel insignificant
• Stating stereotypes makes the patient encourage something similar
• In denial with the client prevents the patient with the ability to talk

Do Not

• Overly interpret clients messages
• Interject with a topic unrelated to the clients problems.
• Do not ask "Why" questions
• This will create the impression it's wrong to do so

Explore therapeutic communication: context, goals, and proxemics. Understand appropriate touch and communication strategies for patients, especially those with trauma histories. Essential concepts for effective nursing practice.