Therapeutic Communication Techniques Quiz

Therapeutic Communication Techniques

• Silence - an effective way for patients to process thoughts and feelings
• Active listening - paying attention to both verbal and nonverbal cues
• Clarifying techniques - rephrasing, summarizing, or using simple language to confirm understanding
• Open-ended questions - inviting patients to share their experiences, perceptions, or responses
• Closed-ended questions - seeking a "yes" or "no" response
• Nontherapeutic communication can hinder the therapeutic relationship and should be avoided
  • Examples: excessive questioning, giving approval or disapproval, giving advice, asking "why" questions

Cultural Considerations

• Communication style, use of eye contact, perception of touch, and cultural filters greatly influence communication in healthcare

Telehealth Technologies

• Can provide access to healthcare for patients in rural areas, chronically ill, homebound, and underserved individuals
• Can also pose challenges with confidentiality, documentation, informed consent, record maintenance, and the safety of transmitted information

Therapeutic Communication Examples

• Congruent message: "You say you look forward to the meeting, but you appear anxious or unhappy."
• Non-therapeutic communication: "I notice that you frowned and avoided eye contact just now. Don't you feel well?"

Therapeutic Groups

• Offer advantages of multiple members receiving treatment simultaneously, reducing costs and providing diverse perspectives
• Provide a safe environment for learning and practicing new communication skills

Interview Preparation

• Pace: allow the patient to set the pace of the conversation
• Setting: establish a setting that promotes security and a sense of safety
• Seating: position yourself at the same vertical level as the patient to convey respect and equality

Nonverbal Communication

• Body language: posture, gestures, facial expressions, and eye contact can reveal emotions and underlying feelings
• Verbal and nonverbal communication should align to avoid incongruent messages

Therapeutic vs. Non-therapeutic Communication

• Therapeutic communication: aims to build trust, empathy, and understanding, facilitating healing and positive patient outcomes
• Non-therapeutic communication: can be harmful and detrimental to the therapeutic relationship.
  • Examples: offering opinions instead of support, interrupting silence, giving approval or disapproval

Patient-Centered Interview

• Fundamental elements: restating, encouraging description of perception, summarizing are key
• Non-therapeutic element: asking “why” questions.

Examples of Therapeutic Communication

• Reflection: "So you are saying that life has no meaning."
• Active Listening: "You seem upset. Please tell me more about what you experienced last night."

Patient Confidentiality

• Confidentiality is paramount: the nurse should not share information about the patient with others
• Documentation is essential to ensure accurate record keeping and continuity of care

Milieu Management

• Milieu management involves creating a therapeutic environment to help patients recover.
• This involves orienting patients to their rights and responsibilities, providing culturally sensitive care, selecting activities that meet their needs, and using the least restrictive environment.

Patient-Centered Care

• Patient-centered care prioritizes the patient's needs, preferences, and values.
• The core concepts include respect, collaboration, communication, and empowerment.

Therapeutic Relationships

• A therapeutic relationship involves the nurse using their communication skills and understanding of human behavior to help the patient grow.
• This relationship focuses on the patient's needs and concerns, respecting them, and using clear communication.
• The nurse's personal needs should be addressed outside of the relationship.

Boundaries

• Boundaries are limits that help maintain a professional relationship between the nurse and the patient.
• Boundary crossing occurs when these limits are violated.
• Examples include disclosing personal information, engaging in personal relationships, or accepting gifts.

Transference and Countertransference

• Transference occurs when the patient unconsciously transfers feelings and behaviors from past relationships onto the nurse.
• Countertransference is the reverse, where the nurse unconsciously displaces feelings onto the patient.

Phases of a Therapeutic Relationship

• Preorientation Phase: Preparation and gathering information about the patient.
• Orientation Phase: The initial meeting where the nurse conducts an interview.
• Working Phase: The nurse and patient work together to achieve goals and explore issues.
• Termination Phase: The end of the therapeutic relationship, with discussion about the patient's progress, future plans, and ways to manage their needs.

Factors that Promote Patient Growth

• Genuineness: Being authentic and real.
• Empathy: Understanding the patient's perspective with compassion.
• Positive Regard: Respecting and valuing the patient.

Verbal and Nonverbal Communication

• Verbal Communication: The words used.
• Nonverbal Communication: Includes tone of voice, facial expressions, body language and posture.

Incongruent Messages

• These occur when a person in power sends conflicting messages, creating confusion.

Therapeutic Communication Techniques

• Techniques that are helpful in achieving health-related goals.
• These include using silence, active listening, clarifying techniques, and asking open-ended and closed ended questions.

Nontherapeutic Communication

• Communication that can hinder the therapeutic relationship.
• Examples include excessive questioning, giving approval or disapproval, giving advice, and asking "why" questions.

Cultural Considerations

• Communication across cultures can be challenging.
• Nurses should be aware of cultural differences in verbal communication styles, use of eye contact, and perception of touch.

Telehealth Technologies

• Advantages: Improve access to care for rural, homebound, and underserved individuals.
• Disadvantages: Concerns about confidentiality, documentation, informed consent, and the safety of transmitted information.

Group Therapy

• Planning Phase: The group leader defines the group's name, objectives, schedule, and responsibilities.
• Orientation Phase: The leader creates a safe environment for trust and confidentiality.
• Working Phase: The leader facilitates communication, promotes group processes, and facilitates group conduct.
• Termination Phase: The leader helps members summarize their progress and set future goals.

Advantages of Group Therapy

• Cost-Effective: Less expensive than individual therapy.
• Learning from Others: Opportunity to learn from experiences of other group members.
• Feedback: Receive feedback from the leader and group members.
• Interpersonal Skills Practice: Safe environment to practice communication skills and social interactions

Torts

• Intentional Torts: Willful acts that violate another person's rights or property. Examples include assault, battery, and false imprisonment.
• Unintentional Torts: Unintentional acts that cause harm. Examples include negligence and malpractice.

Standards for Nursing Care

• Nurses are held to a standard of care based on what other competent nurses would do in similar situations.

Objective Documentation

• Objective documentation is essential for documenting patient care. This includes recording observations, assessments, and interventions for legal and safety reasons.

Domestic Violence

• Nurses may encounter patients who are victims of domestic violence or have family members who exhibit controlling behavior.
• The nurse's role is to promote safety, remain calm, listen to the patient, and document any observations.

Medication Education

• Goals for Medication Education Group Sessions:
  • Patients identifying side effects of medication.
  • Patients understanding the purpose of their medications.
  • Patients correctly identifying dosage schedules.
  • Patients understanding potential drug-drug and drug-food interactions.

Group Management

• Managing a Monopolizing Group Member: The leader can ask the group if someone else would like to share, or suggest that the member take time to think about their thoughts.

Boundary Blurring (Example from Text):

• Boundary Blurring: This refers to the example of two patients who are discussing meeting for a playdate with their daughters. This is blurring the professional boundaries between the nurse and the patient.

Refraining from Self Harm

• Strategies to increase socialization should be described
• Describe at least two strategies to increase self-care

### Medical Records - Legal Documents

• Legal documents must reflect the patient’s condition and changes.
• Documentation should be based on professional standards.
• Proper documentation should follow nursing regulatory agencies, reimbursement requirements and professional standards.

Enhancing Documentation

• Using the nursing process as a guide enhances proper documentation.

### Armani’s Medical Record

• Armani is a 40 year old African national in a psychiatric outpatient setting
• He is in treatment due to a court order.
• His medical record has limited scope.
• Nurses can access past medical records within the current facility to obtain more data.

Psychiatric Health Assessment

• Establishing a rapport with the patient is important.
• The purpose is to understand the patient's current problem or chief complaint.
• It’s important to assess for risk factors affecting the safety of the patient or others.
• A mental status examination is necessary to establish a baseline.
• Psychosocial status should be assessed.
• Mutual treatment goals should be identified.
• Formulate a plan of care.
• Document all data in a retrievable format.

Milieu Therapy

• Milieu therapy is a psychiatric philosophy that involves a secure environment.
• A secure environment includes people, settings, structure, and emotional climate to support recovery.
• Milieu therapy utilizes naturally occurring events in the environment as learning opportunities for patients.
• It maintains a consistent routine and structure to provide predictability and trust.

Therapeutic Communication Responses

• Acknowledge the patient's feelings and concerns.
• Offer support and encouragement.
• Use open-ended questions to facilitate conversation.
• Avoid giving advice or making judgments.

Therapeutic Communication

• Therapeutic communication builds a strong foundation for a patient-centered interview.

Nontherapeutic Communication

• Avoid excessive questioning.
• Do not give approval or disapproval.
• Do not ask "why" questions.

Communicating Across Cultures

• Communication style, eye contact, touch and cultural filters pose challenges for healthcare workers.

Telehealth Technologies: Advantages

• Provides access to people who might otherwise not receive care.
• Helps patients in rural areas.
• Benefits chronically ill, homebound, and underserved individuals.

Telehealth Technologies: Disadvantages

• Confidentiality is an issue.
• Documentation is also impacted.
• Informed consent and record maintenance are impacted.
• The safety of transmitted information is often compromised.

Therapeutic Communication Techniques - Nurse - Patient Interactions

• Active listening
• The use of clarifying techniques
• Strategic use of silence
• Asking open-ended questions
  • Encourage the patient to share information.
  • Examples:
    • "What do you perceive as your biggest problem right now?"
    • "What is an example of some of the stresses you are under right now?"
    • "How would you describe your relationship with your wife?"
• Asking closed-ended questions
  • Patients can respond with “yes” or “no”.

Nontherapeutic Communication

• Excessive Questioning: Can become intrusive to the patient
• Giving approval or disapproval: Indicates that the patient should think or feel a certain way
• Giving advice: Can prevent the patient from finding their own solutions
• Asking “why" questions: Makes the patient feel defensive.

Cultural Considerations

• Communication style, eye contact, perception of touch, and cultural filters all impact care delivery.

Incongruent Messages

• These are characterized by two or more mutually contradictory messages given by a person in power.
• They can be a mix of content (what is said) and process (what is conveyed nonverbally).

Therapeutic Communication Techniques

• Silence: Can allow the patient to reflect and gather their thoughts.
• Active Listening: Paying full attention to the patient's verbal and nonverbal cues.
• Clarifying Techniques: Asking questions to ensure that the nurse understands the patient's message.

Therapeutic Groups: Advantages

• Multiple members can be in treatment simultaneously, reducing costs.
• Members can learn from other participants' experiences and insights.
• Therapeutic groups can provide a safe space to practice new communication skills.

### Intentional Torts

• Assault: Threatening to harm a patient without their consent.
• Battery: Touching a patient without their consent.
• False Imprisonment: Unjustifiably detaining a patient against their will
• Unintentional Torts: Unintended acts against a person that cause injury or harm.

Unintentional Torts: Negligence vs. Malpractice

• Negligence: A failure to provide the standard of care that a reasonably prudent nurse would provide.
• Malpractice: Negligence by a professional, often involving a breach of the standard of care.

Standards for Nursing Care

• Based on what other nurses with the same skill level would do in a similar situation.

Sources for Standards of Care

• State Boards of Nursing: Establish standards of nursing practice and issue licenses.
• Professional Associations: Set standards for nursing practice and provide continuing education.
• Institutional Policies and Procedures: Provide guidance for nursing care within specific healthcare organizations.
• Custom as a Standard of Care: Practices that are commonly accepted as safe and effective.

Objective Documentation

• Objective documentation is crucial for patient safety.
• The information should describe the situation in a factual and impartial manner.
• This is particularly important for cases of domestic violence or abuse.
• Objective documentation helps to ensure that care is delivered appropriately and that legal requirements are met.
• It also can help to prevent potential legal problems.

Potential Threats to Patient Safety

• Family members or friends of the patient can pose threats to the patient's safety.
• It is essential that nurses identify and document any concerning behaviors.

### Nurses Should Remain Calm When Family Members are Threatening

• Nurses should remain calm, listen carefully, and reassure family members that their contributions are important.

Informed Consent in Mental Health Care

• Informed consent empowers patients to make deliberate decisions about their treatment by ensuring they understand the risks, benefits, and alternatives.
• It aligns with ethical principles of autonomy and respect for patient choices.

Standards of Practice for Nursing in Mental Health

• Assessment: Understanding cultural and language barriers crucial for accurate patient assessment.
• Diagnosis: Identifying problems and needs within the nurse's scope of practice.
• Outcomes/Identification: Setting goals and objectives to guide treatment.
• Planning: Developing strategies and interventions based on patient needs and goals.
• Implementation: Putting the plan into action through interventions and care.
• Evaluation: Assessing the effectiveness of interventions and adjusting care as needed.
• Documentation is essential for legal and medical purposes. It should be precise and accurate, using clear terms like "non-adherence" instead of "non-compliant."

Nursing Care Plan Example

• The statement "Mr. S sometimes forgets to eat" would most likely be found in the Assessment stage of the nursing care plan.
• The nurse would then use this information to develop interventions, such as offering frequent snacks, which would be documented in the Planning and Outcomes Identification section.

Language Barriers

• Interpreter: Translates spoken words between languages or between spoken and sign language.
• Translator: Translates written words between languages.

Types of Nursing Diagnosis

• Problem: Describes the patient's current state.
• Probable Cause: Identifies what needs to be addressed to bring about change.
• Supporting Data: Objective signs (measurable) and subjective symptoms (reported by the patient) to justify the diagnosis.

Milieu Management

• Involves creating a therapeutic environment that promotes patient well-being and recovery:
  • Orienting patients to their rights and responsibilities.
  • Providing culturally sensitive care.
  • Selecting activities that meet physical and mental health needs.
  • Using the least restrictive environment possible.

Patient- and Family-Centered Care

• Core concepts:
  • Respect and dignity: Treating patients as individuals with unique needs and preferences.
  • Information sharing: Openly communicating with patients and families about their care.
  • Participation: Encouraging patients and families to actively participate in care decisions.
  • Collaboration: Working together to develop and implement care plans.

Therapeutic Self

• The nurse's ability to use communication skills, understanding of human behavior, and personal strengths to enhance the patient's growth.
• Focuses on the patient’s ideas, experiences, and feelings.
• Avoids allowing personal needs or feelings to interfere with the therapeutic relationship.

Boundaries

• Define the limits of the nurse-patient relationship:
  • Physical boundaries: maintaining appropriate physical space and avoiding physical touch without consent.
  • Emotional boundaries: avoiding oversharing personal information or becoming overly involved in the patient's personal life.
  • Professional boundaries: upholding professional roles and responsibilities and avoiding dual relationships.

Boundary Crossing Examples

• Giving a patient a personal gift.
• Spending excessive time with one particular patient.
• Engaging in inappropriate social interactions with the patient.

Transference and Countertransference

• Transference: The patient unconsciously displaces feelings towards significant figures in their past onto the nurse.
• Countertransference: The nurse unconsciously displaces feelings towards significant figures in their past onto the patient.

Peplau's Model of the Nurse-Patient Relationship

• Preorientation Phase: The nurse prepares for the encounter by reviewing the patient's medical history and treatment plan.
• Orientation Phase: The initial meeting between the nurse and patient, establishing trust and rapport.
• Working Phase: The focus is on problem-solving and achieving therapeutic goals.
• Termination Phase: The end of the relationship, allowing the patient to reflect on progress and prepare for the future.

Therapeutic Communication and the Nurse-Patient Relationship

• Attending Behavior: Nonverbal cues that show the nurse is actively listening and paying attention to the patient (e.g., maintaining eye contact, sitting facing the patient, nodding, using verbal cues).
• Empathy: Understanding and acknowledging the patient's feelings and perspectives without judgment.
• Reflection: Restating the patient's feelings and thoughts back to them to demonstrate understanding.
• Communication Errors: Avoiding behaviors that could harm the patient, such as misunderstandings, misinterpretations, or failing to provide complete and accurate information.

Group Therapy

• Planning Phase:* The group leader:
  • Identifies the group’s name, objectives, target population, schedule, physical setting, seating configuration, leader and member responsibilities, and evaluation methods.
• Orientation Phase:* The leader fosters respect, confidentiality, and trust.
• Working Phase:* The leader facilitates communication and group processes.
• Termination Phase:* The group summarizes accomplishments, shares insights, and identifies future goals.

Communication Channels

• Auditory: Listening to verbal communication.
• Visual: Observing nonverbal cues and written information.
• Tactile: Using touch if appropriate.
• Olfactory: Noticing smells that could indicate a health concern.

Advantages of Group Therapy

• Less expensive than individual therapy.
• Provides a safe environment for learning from others with similar experiences.
• Offers feedback from both the group leader and other members.
• Allows for practice of interpersonal skills in a safe setting.

Test your knowledge on therapeutic communication techniques essential in healthcare settings. This quiz covers skills such as active listening, open-ended questions, and the impact of cultural considerations. Additionally, explore the significance of telehealth technologies in enhancing patient communication.