Therapeutic Communication PDF

# Therapeutic Communication ## Introduction Communication is the fundamental base for establishing nurse-patient relationships. It is extremely important to a psychiatric nurse for assisting patients to regain psychological or physiological functional normality, identify, explore problems, and to...

# Therapeutic Communication ## Introduction Communication is the fundamental base for establishing nurse-patient relationships. It is extremely important to a psychiatric nurse for assisting patients to regain psychological or physiological functional normality, identify, explore problems, and to meet emotional needs in a healthy way. ## Definition of Communication It is a process in which people affect one another through the exchange of information, ideas, and feelings. Or, messages are simultaneously sent and received on two levels: verbally through the use of words and nonverbally by behaviors that accompany the words. ## What is Therapeutic Communication? Therapeutic communication is an interpersonal interaction between the nurse and the client during which the nurse focuses on the client's specific needs to promote an effective exchange of information. Therapeutic communication can help nurses to accomplish many goals: - Establish a therapeutic nurse-client relationship. - Identify the most important client concern at that moment. - Assess the client's perception of the problem. - Facilitate the client's expression of emotion. - Teach the client and family necessary self-care skills. - Recognize the client's needs. - Implement interventions designed to address the client's needs. - Guide the client toward identifying a plan of action to a satisfying and socially acceptable resolution. ## Elements of Communication: 1. **Referent**: Stimulus, the need or reason for communication to occur 2. **Sender**: The person who encodes and delivers the message (encoder) 3. **Message**: The content of communication; information sent or expressed to another, it may be verbal or nonverbal. 4. **Medium**: The method by which the message is sent through: auditory (hearing), visual (seeing), or tactile (touch medium). - For example: you get a message from a patent at a painful condition you hear complaints of pain, you see tears in their eyes, they grasp your arm in pain. 5. **Receiver**: The person who receives and interprets the message (decoder). 6. **Feedback**: The message or response, which is returned by the receiver; it indicates whether the meaning of the sender's message was understood. ## **Forms or Types of Communication**: Communication consists of verbal and nonverbal communication; it is said that communication is roughly 10% verbal and 90% nonverbal, therefore learning to be effective communication means using both verbal and nonverbal cues. ### 1) Verbal Communication: Verbal Communication consists of the words a person uses to speak to one or more listeners. ### **Effective Verbal Communication**: Effective verbal communication contains a message that must be: - Clear - Brief - Pacing - Timing & Relevance - Intonation ### 2) Nonverbal Communication: - Personal appearance - Eye Contact - Posture and gait: Are forms of self-expression. - Facial expression: The face is the most expressive part of the body. - Paralanguage: Includes tone of voice and sound. - Touch: It is a powerful tool that conveys both negative and positive expressions. - Personal space: The area with invisible boundaries surrounding the persons' body. - Gesture: ## Techniques that Enhance Communication 1. **Silence**: Absence of verbal communication, which gives the person time to collect thoughts or to think through a point (e.g., encourages a person to talk by waiting for the answers). 2. **Accepting**: Indicates reception. An accepting response indicates the nurse has heard and followed the train of thought. - Example: - Yes - Uh-huh - I follow what you say". Nodding 3. **Giving Recognition**: Acknowledge indicates awareness: Greeting the client by name, indicating awareness of change or noting efforts the client has made all show that the nurse recognizes the client as a person. - Example: - Good morning, Mr. Jones. - You've combed your hair today. - I notice that you shaved today. 4. **Offering Self**: Making one- self available. The nurse can offer her presence, interest, and a desire to understand. It is important that this offer is unconditional, that is, the client does not have to respond verbally to get the nurse's attention. - Example: - I would like to spend time with you. - I'll stay here and sit with you a while. 5. **Offering General Leads**: Giving encouragement to continue. General leads indicate that the nurse is listening and following what the client is saying without taking away the initiative for the interaction. - Example: - Go on - And then? - Tell me about it 6. **Giving Broad Openings:** Allowing the client to take the initiative in introducing the topic. - Example: - Where would you like to begin? - Is there something you'd like to talk about? 7. **Placing the Events in Time or Sequence**: Clarifying the relationship of events in time. Putting events in proper sequence helps both the nurse and the client to see them in perspective. The client may gain insight into cause and effect behavior and consequence. - Example - What happened before? - When did this happen? What seemed to lead up to ......? 8. **Making Observations**: Verbalize what the nurse perceives. Sometimes clients cannot verbalize or make themselves understood, or the client may not be ready to talk. - Example: - You appear tense. - I notice you're biting your lips. - You appear nervous whenever Mr. X enters the room. 9. **Encouraging Description of Perception**: Asking the client to verbalize what he or she perceives. Encouraging the client to describe ideas fully may relieve the tension the client is feeling and he or she may be less likely to take action on ideas that are harmful or frightening. - Example: - What do these voices seem to be saying? - What is happening now? - Tell me when you feel anxious. 10. **Encouraging Comparison**: The client benefits from making these comparisons because he or she might recall past coping strategies that were effective or remember that he or she has had a similar situation. - Example: - Was it something like...? - Have you had similar experiences? 11. **Restating**: Repeating the main idea expressed. The nurse repeats what the client has said in approximately or nearly the same words the client has used. This restatement lets the client know that he or she communicated the idea effectively. - Example: - Client: I can't sleep. I stay awake all night. - Nurse: You've had difficulty sleeping? - Client: I'm really mad. I'm really upset. - Nurse: You're really mad and upset. 12. **Reflecting**: Directing questions, feelings, and ideas back to the patient. Reflection encourages the client to recognize and accept their own ideas and feeling. The nurse indicates that the client's point of view has value and that the client has the right to have opinions and make decisions and to think independently. - Example: - Client: Do you think I should tell the doctor...? - Nurse: Do you think you should? - Client: My brother spends all of my money and then has the nerve to ask for more. - Nurse: This causes you to feel angry? 13. **Focusing**: Concentrates attention on a single point. It is especially useful when the patient jumps from topic to topic. - Example: - This point you are making about leaving school seems worth looking at more closely. 14. **Exploring**: Delving further into a subject or an idea. When clients deal with topics superficially, exploring can help them examine the issue more fully. If the client expresses an unwillingness to explore, the nurse respects the patient's wishes. - Example: - Tell me more about that. Would you describe it more fully? 15. **Giving Information**: Making available facts that the client needs. Giving information builds trust with the client. - Example: - My name is.... - Visiting hours is... - My purpose in being here... 16. **Presenting Reality**: Offering for consideration that which is real. The nurse does this by calmly and quietly expressing his or her perception or the facts, not by way of arguing with the client. - Example: - Your mother is not here; I am a nurse. 17. **Voicing Doubt**: Expressing uncertainty about the reality of the client's perceptions. The nurse neither agreed nor disagreed but let the misperception and distortions pass without comment. - Example: - Isn't that unusual? 18. **Translate into Feeling**: Seeking to verbalize the client's feeling that he or she expresses only indirectly. - Example: - Client: I am dead. - Nurse: Are you suggesting that you feel lifeless? Does life seem meaningless to you? 19. **Suggesting Collaboration**: Offering to share, to strive, and to work with the client for his or her benefit. - Example: - Perhaps you and I can discover what produces your anxiety. 20. **Summarizing:** Brings together important points of discussion to enhance understanding. - Example: - Have I got this straight? You said, during the past hour, you and I have discussed...? 21. **Formulation a Plan of Action**: - Asking the client to consider kinds of behavior likely to be appropriate in future situations. - Example: - What could you do to let your anger out harmlessly? 22. **Consensual Validation**: Searching for mutual understanding, for according the meaning of the word. - Example: - Are you using this word to convey that...? ## **Characteristics of Successful Communication** 1. **Flexibility** - Through an absence of under control when the participant does and says as they want, or over control occurs when there is checking communication exchanged. 2. **Efficiency**: - The language used by the communication is understood and there is enough time between verbal response for the listener to perceive and evaluate them. 3. **Appropriateness**: - The reply is fitting and relevant to the communication received. 4. **Feedback**: - The return response it is the response of the listener, which indicates the effect, made by the communication received. ## **Factors Affecting Communication** ### Internal Factors 1. The content of the message 2. Perceptions 3. The ability of the communicator 4. Knowledge level 5. Age 6. Preoccupation 7. Physical Status ### External Factors 1. Climate: - If the weather is too cold or too hot, this effect good communication. 2. Time: - Time of communication should be suitable for both the sender & receiver - Example: Nurses should not teach patients who are in severe pain or emotional stress. 3. Light - If the room is dark, this prevents good communication 4. Noisy - If the location is noisy, the message may not be heard. 5. Crowding: - If the location of communication consists of a large number of people, this can lead to discomfort and affect good communication. 6. Place: - The place must be graded to allow enough visibility and convey the message. ## Measures to Improve Communication - Maintain active listening, e.g. Maintain eye contact, give full attention. - Clarify ideas before attempting to communication e.g. is sure of what they want to communicate. - Examine the purpose of communication, be quite clear about the purpose what you want. - Provide the right climate and environment, e.g. calm, comfort, safe, not crowded or noisy, and good light. - Use clear language, e.g. use simple clear understood by the receiver. - Use adequate medium, e.g. select oral, visual, or written medium that considers the most affective. - Provide a climate of trust and confidence. - Watch carefully the tone of the voice. ## Multiple Choice Questions Select the best answer for each of the following: 1. C:" I had an accident" N: "Tell me about your accident" This is an example of which therapeutic communication technique? a. Making observation b. Offering self c. General lead d. Reflections 2. "Earlier today you said you were concerned that your son was still upset with you. When I stopped by your room about an hour ago, you and your son seemed relaxed and smiling as you spoke to each other. How did things go between the two of you? This is an example of which therapeutic communication technique? a. Consensual validation b. Encouraging comparison c. Accepting d. General lead 3. When the client says, "I met Joe at the dance last week," what is the best way for the nurse to ask the client to describe her relationship with Joe? a. "Joe who" b. "Tell me about Joe." c. "Tell me about you and Joe." d. "Joe you mean that blond guy with the dark blue eyes?" 4. Which of the following are examples of a therapeutic communication? a. "Don't worry - everybody has a bad day occasionally." b. "I don't think your mother will appreciate that behavior." c. "Let's talk about something else." d. "Tell me more about your discharge plans." e. "That sounds like a great idea." f. "What might you do the next time you're feeling angry?" ## List The Following: 1. Characteristics of successful communication. 2. Factors affecting communication 3. Measures to improve communication.