N112 Therapeutic Communication-Davis PDF

Therapeutic Communication Beena Davis, Ph.D., RN N112 1 1 Objectives  Describe the components of the communication process.  Discuss factors that influence communication.  Identify effective transcultural communication skills when plan care for clients of other cultures.  Describe the therapeuti...

Therapeutic Communication Beena Davis, Ph.D., RN N112 1 1 Objectives  Describe the components of the communication process.  Discuss factors that influence communication.  Identify effective transcultural communication skills when plan care for clients of other cultures.  Describe the therapeutic communication techniques  Discuss the purpose of hand-off communication or change-ofshift report.  Discuss the therapeutic relationship.  Describe the characteristics of the therapeutic relationship.  Discuss phases of the therapeutic relationship.  Identify the factors that promote effective communication.  Describe interview techniques.  Discuss communication styles. 2  Identify barriers to communication. 2 Required Reading Chapter 8, p#172-207 Chapter 1, p#15 3 3 1 Empathy: The Human Connection to Patient Care https://www.youtube.com/watch ?v=cDDWvj_q-o8 4 4 Communication The process of exchanging information and generating and transmitting meanings between two or more people Nurses must be proficient in communication skills as they are in clinical skills. 5 5 The Communication Process Stimulus or referent Sender or source of message (encoder) Message Channel (Medium) of communication Receiver (decoder) Feedback 6 6 2 Components in the Process of Communication 7 7 Forms of Communication Verbal Nonverbal Communication Technologies Electronic 8 8 Levels of Communication Intrapersonal Self-talk; communication within a person Interpersonal Occurs between two or more people with a goal to exchange messages Group Small-group Organizational communication Group dynamics 9 9 3 Factors Influencing Communication Developmental level Sociocultural differences Roles and responsibilities Physical, mental, and emotional state Values Environment 10 10 Factors Influencing Communication… Space and territoriality Intimate zone Personal zone Social zone Public zone 11 11 Professional Communication in the Nursing Process Assessing Analyzing Outcome identification and planning Implementing Evaluating 12 12 4 Documenting Communication Continual assessment of patient needs and conditions Continuity of care Convey the information 13 13 Effective professional communication  Hand-off communication: SBAR  Situation  Background  Assessment  Recommendations Refer p#186  I-SBAR-R  Identification of yourself and your patient  Readback  The hand-off TST (Targeted Solutions Tool) 14 14 Therapeutic Nurse-Patient Relationship Does not occur spontaneously Characterized by an unequal sharing of information Built on the patient’ s needs 15 15 5 Characteristics of the Therapeutic Nurse-Patient Relationship Caring, person-centered Dynamic Purposeful and time limited The person providing assistance is professionally accountable for the outcomes and the means used to attain them. 16 16 Goals of the Therapeutic Relationship Increased independence for the patient Greater feelings of worth Improved well-being 17 17 Phases of the Therapeutic Relationship Orientation phase Working phase Termination phase 18 18 6 Goals of the Orientation Phase The patient will call the nurse by name. The patient will accurately describe the roles of the participants in the relationship. The patient and nurse will establish an agreement about: Goals of the relationship Location, frequency, and length of the contacts Duration of the relationship. 19 19 Goals of the Working Phase The patient will actively participate in the relationship. The patient will cooperate in activities that work toward achieving mutually acceptable goals. The patient will express feelings and concerns to the nurse. 20 20 Goals of the Termination Phase The patient will participate in identifying the goals accomplished or the progress made toward goals. The patient will verbalize feelings about the termination of the relationship. 21 21 7 Factors Promote Effective Communication Dispositional traits Rapport builders 22 22 Dispositional Traits Warmth and friendliness Openness and respect Empathy Honesty, authenticity, trust Caring Competence 23 23 Rapport Builders Specific objectives Comfortable environment Privacy Confidentiality Patient vs. task focus Utilization of nursing observations Optimal pacing 24 24 8 Effective Transcultural Communication Skills       Assess your personal beliefs Assess communication variables Plan care based on communicated needs Modify communication approaches Respect for the patient and communicated needs Non-threatening manner  Use validating techniques  Be considerate of reluctance to talk  Adopt special approaches  Use interpreters Refer p# 190, Box 8-4 25 25 Through the Eyes of a Patient List of simple things that you can communicate each time you walk into my home or room  Really listen to me  Ask me what I think  Don’t dismiss my concerns  Don’t treat me like a disease, treat me like a person  Talk to me, not at me  Respect my privacy  Don’t keep me waiting  Don’t tell me what to do without telling me how to do it  Keep me informed  Remember who I used to be 26  Let me know you care. 26 Therapeutic Communication Techniques  Listening  Silence  Restating  Reflection  Clarification  Focusing  Broad openings  Humor  Informing  Sharing perceptions  Theme identification  Suggesting 27 Refer Hinkle & Cheever 15th ed. P#15, Table 1-2 27 9 28 28 Developing Professional Therapeutic Communication Skills Conversation skills Listening skills Silence Touch Humor 29 29 Developing Conversation Skills Control the tone of your voice. Be knowledgeable about the topic of conversation. Be flexible. Be clear and concise. Avoid words that might have different interpretations. Be truthful. Keep an open mind. Take advantage of available opportunities. 30 30 10 Developing Listening Skills Sit when communicating with a patient. Be alert and relaxed and take your time. Keep the conversation as natural as possible. Maintain eye contact if appropriate. Use appropriate facial expressions and body gestures. Think before responding to the patient. Do not pretend to listen. Listen for themes in the patient’s comments. 31 31 Silence, Touch, Humor  Use silence appropriately, allowing the patient to gather his or her thoughts and to proceed at his or her own pace.  Touch is a powerful means of communication with multiple meanings.  Humor is increasingly used as both an interpersonal skill for the nurse and a healing strategy for patients. 32 Use silence, therapeutic touch, and humor appropriately. 32 Interviewing Techniques Open-ended question or comment Closed question or comment Validating question or comment Clarifying question or comment Reflective question or comment Sequencing question or comment Directing question or comment 33 33 11 Assertive Behavior  Confident; open body posture  Use of clear, concise “I” statements  Ability to share effectively one’s thoughts, feelings, and emotions  Working to capacity with or without supervision  Remaining calm under supervision  Asking for help when necessary  Giving and accepting compliments  Admitting mistakes and taking responsibility for them 34 34 Aggressive Behavior  Involves asserting one’s rights in a negative manner that violates the rights of others  Can be verbal or physical  Communication is marked by tension and anger, inhibiting the formation of good relationships and collaboration.  Characteristics include using an angry tone of voice, making accusations, and demonstrating belligerence and intolerance.  Focus is usually“winning at all costs.” 35 35 Barriers to Communication Failure to perceive the patient as a human being Failure to listen Nontherapeutic comments and questions Clichés Closed questions Questions containing the words “why” and “how” Questions that probe for information 36 36 12 Barriers to Communication… Leading questions Comments that give advice Judgmental comments Changing the subject Giving false assurance Gossip and rumor 37 37 Disruptive Interpersonal Behavior and Communication Incivility and Bullying Horizontal or lateral violence Negative communication between nurse and physician Verbally and physically aggressive patients 38 38 Disruptive Interpersonal Behavior…  Responses to Disruptive Behaviors and Communication Education Accountability Zero-tolerance policy Training for leaders Reporting Documenting 39 39 13 Impaired Verbal Communication Communicating with Patients Who Have Special Needs  Visually impaired  Deaf or hard of hearing  Physical barrier  Cognitively impaired  Unconscious  Unable to speak English Refer p#203, Box 8-6 40 40 References  Taylor, C., Lynn, P. & Bartlett, J.L. (2023). Fundamentals of nursing. The art and science of person-centered care (10th ed.). Wolters Kluwer.  Hinkle, J. L., Cheever, K. H., & Overbaugh, K.J. (2022). Brunner & Suddarth’s textbook of medical-surgical nursing, (15th ed.). Wolters Kluwer. 41 41 14