Therapeutic Communication Techniques PDF

lOMoARcPSD|45643264 Therapeutic Communication Techniques fundamentals of nursing (Raritan Valley Community College) Scan to open on Studocu Studocu is not sponsored or endorsed by any college or university...

lOMoARcPSD|45643264 Therapeutic Communication Techniques fundamentals of nursing (Raritan Valley Community College) Scan to open on Studocu Studocu is not sponsored or endorsed by any college or university Downloaded by Kent Spencer Mondido ([email protected])  lOMoARcPSD|45643264 Nursing 311 TECHNIQUES OF THERAPEUTIC COMMUNICATION Technique Description Example Broad opening To allow the patient to pick the topic, take Where would you like to begin? statements the initiative to express self, and set the What is on your mind today? direction of the conversation. What are you thinking about? Note: there is no topic is given by the Is there anything you would like to discuss? student. The patient gives the topic in response. Offering general Encourages the client to continue and that Go on. leads the nurse is interested in what comes next. And then? Tell me about it. Exploring Examines certain ideas, experiences, or What kind of relationship do you have with your relationships more fully. children? Tell me about your coping mechanisms? What brought you here to the hospital? Focusing Helps the patient focus on a certain point Let’s stop and look more closely at your feelings when they are jumping from topic to topic. about managing your medications. The patient is talking about many things at You’ve mentioned many things. Let’s go back to once and you focus in on one topic. your thinking of “giving up”. Silence Provides time for the patient to put Maintain an interested, expectant silence. thoughts or feelings into words, regain (If you are silent because you are uncomfortable or composure or continue talking. don’t know what to say, then it’s a block and should be processed as such.) Accepting Indicated the patient has been understood. Uh-hmm. It does not indicate agreement and is Yes. nonjudgmental. I’m following you. Nodding. Giving recognition Indicated awareness of change in personal Good morning, Mr. Jones. efforts. Does not imply good or bad, right or I see you have put on your jewelry today. wrong. You’ve finished your list of things to do. Offering self Offers presence, interest, and a desire to I’ll sit with you her for a while. listen to the patient. I would like to spend some time with you. I’m available if you need to talk. Sharing Calls attention to the patient’s physical You appear tense. observations behavior or emotional state. How a person I noticed that you are biting your lip. looks, sounds or acts. Verbalizing what the You seem upset. nurse perceives. You are trembling. Paraphrasing Repeating the main idea in order to be sure Patient: “I have been tossing and turning all night.” the patient has been understood. Nurse: “You are having difficulty sleeping.” Restating another’s message more briefly Patient: “I just give up.” Nurse: “You don’t see the using one’s own words. point of trying anymore.” Patient: “I’ve been overweight all my life and never had any problems. I can’t understand why I need to be on a diet.” Nurse: “You are not convinced that you need a diet because you’ve stayed healthy.” Reflecting Directing questions, feelings and ideas Patient: “What do you think I should do about back to the patient. Acknowledges the telling my employer about my illness?” Nurse: patient’s right to have opinions and “What have you been thinking about this make decisions. situation?” Patient: “Everyone ignores me”. Nurse: “Ignores you?” Providing Makes facts available in order to assist This medication is for you high blood pressure. information in decision-making or drawing This test will determine your treatment conclusions. options. My purpose for being here is… Downloaded by Kent Spencer Mondido ([email protected]) 1  lOMoARcPSD|45643264 Technique Description Example Sharing Empathy Acknowledging feelings. To help the Patient: “I hate it here. I wish I could go home.” patient know that feelings are Nurse: “It must be difficult to stay in a place understood and accepted. Attempting you hate.” to see the situation through the client’s This diagnosis has been life changing. eyes. You have a lot on your plate. Seeking To make clear that which is vague or I am not sure I follow you. Clarification maximize understanding between the What would you say the main point of what you nurse and patient. Asking for further said was? explanation or an example. Can you give me an example of a time you thought everyone hated you. Verbalizing To voice what the patient has implied. Patient: “I can’t talk to you or anyone else implied thoughts To verify impressions to help the because it’s a waste of time.” Nurse: “Do you and feelings patient more fully aware of feelings feel that no one understands?” expressed. Patient: “My wife pushes me around just like my mother and sister did.” Nurse: “Is it your impression that women are domineering?” Sharing humor Discharge of energy through comic This gives a whole new meaning to “just relax”. enjoyment of the imperfect. Can reduce tension and promote mental well-being. Must be used carefully and sparingly. Seeking Searching for mutual understanding Tell me whether my understanding of it agrees consensual especially when slang terms have been with yours. validation used. Are you using this word to convey that …? Encouraging Brings out recurrent themes by looking Was it something like…..? comparison at similarities or differences. Have you had a similar experience? Has this ever happened before? Encouraging Assists the patient in considering things What did it mean to you when he said her evaluation from their own set of values or couldn’t stay? perspective. How do you feel about your recovery this time in the hospital? Encouraging Asking the patient to verbalize things What is happening right now? description of from their own perspective. Asking to What are you are thinking when you feel perception describe thoughts and feelings. anxious? Placing the event To help the patient see cause and effect When did this happen? in time or in or identify patterns of events and What seemed to lead up to….? sequence actions. Was it before or after….? Sharing hope Communicating a sense of possibility to I believe you will find a way to face your achieve their potential. Commenting on situation because I have seen how you interact the positive aspects of the patient’s with your children in this situation. behavior, performance, and responses. You must personally see the patient display the behavior you base this hope on. It can’t be based on things you did not observe because that is a block called “false reassurance”. Presenting Indicated what is real without arguing. Your mother is not here. I am the nurse. reality Presenting the facts of a situation. I see no one else in the room. Downloaded by Kent Spencer Mondido ([email protected]) 2  lOMoARcPSD|45643264 Technique Description Example Voicing doubt Expressing uncertainty about the reality Really? of the patient’s perceptions. That’s hard to believe. The patient can become aware that Isn’t that unusual. others do not necessarily perceive things in the same way. This is not an attempt to get the patient to change their point of view. Attempting to Seeking to verbalize the patient’s Patient: “I’m dead inside.” Nurse: “Are you translate into feelings that are expressed only saying you feel lifeless?” feelings indirectly. Patient: “I’m way out in the ocean.” Nurse: “Are you saying you feel lonely or deserted?” Encouraging Asking patient to consider kinds of What could you do to let your anger our formulation of an behavior likely to be appropriate in harmlessly? action plan future situations Next time this comes up, how might you handle it? What are other ways you could approach your boss? Summarizing Concise review of the key aspects of the During the past hour, you and I have interaction to bring a sense of discussed… satisfaction and closure. We have discussed many ways to deal with your anger toward you mother. You have agreed to try a few and let me know how it works out. Self-disclosure GENERALIZED sharing of personal That happened to me once, too. It was experiences about the self to benefit the devastating, and I had to face some things patient. about myself that I didn’t like. I went for counseling, and it really helped….What are your thoughts about seeing a therapist? Confrontation Helping the patient become aware of You say you have already decided what to do; inconsistencies in feelings, attitudes, yet you are still talking a lot about your options. beliefs or behaviors. You said you wanted to attend the support This technique can only be used gently group but you stayed in your room all day. and after trust has been established. Recommend or Allows the patient to consider options Have you thought about….? suggest options they may not have previously Here are some things other people in your (do not advise) considered situation have considered…..? Suggesting Offering to share, to strive, to work with Let’s see if we can figure this out. collaboration the patient for their benefit. The nurse Let’s work together to identify triggers to your offers to do things with rather than for anxiety. the patient. Let’s go to your room. I’ll help you find what you are looking for. Using Touch Care must be taken to use touch at the Holding a patient’s hand or placing your hand appropriate time and with the on a patient’s shoulder. appropriate patient. Touch should not be used when someone is paranoid, angry, in a panic state, or has had previous trauma. Sensitivity to cultural and social cues for touch must be practiced. Asking permission may be appropriate in some cases. Downloaded by Kent Spencer Mondido ([email protected]) 3  lOMoARcPSD|45643264 BLOCKS TO THERAPEUTIC COMMUNICATION Technique Description Example Giving Nurse imposes own opinion and What you should do is…. advice/personal solutions on the patient. Implies the Why don’t you…? opinions patient cannot make own decisions. Get out of that situation immediately. These are decisions that are not ours I would leave that person if they did that to me. to make. Asking personal Asking personal questions not relevant Why have you never gotten married? questions/probing to the situation. These questions may What is your political party? be asked due to personal curiosity and not for the client’s benefit. False reassurance Attempts to dispel anxiety by implying Don’t worry, everything will be all right. there is not sufficient reason for You’re doing fine. concern. I wouldn’t worry about that. I’ve felt that way myself sometimes. Automatic Automatic responses like these are Everything happens for a reason. responses/ clichés belittling to the patient’s experience. God doesn’t give you more than you can handle. Minimizes the significance of the Keep your chin up. Everyone gets down in the patient’s feelings. dumps. All old people are hard of hearing. Giving approval/ Not client centered. Opinions and That’s good thinking. Disapproval conclusions should come exclusively Great job! from the patient. Nurses are neutral. I agree. Both can cause dependence on the I’m glad that… healthcare professional because the That’s bad for you. patient may want to please the nurse. I’d rather you wouldn’t. Avoid using good, bad, right, or wrong. That’s not right. Agreeing/ Implies right and wrong, good or bad That’s the right attitude. Disagreeing from the nurse’s point of view. Now, if I agree. the client changes their mind, they are You must be right. “wrong”. Limits their freedom to think That’s not true. or act in a certain way. You’re wrong. Technique Description Example Asking for “Why” questions can also imply right Why do you think that? explanations/ or wrong and may be perceived as Why do you feel that way? “Why” questions threatening or intimidating. If the Why don’t you take your medications? client doesn’t know the answer they Why are you upset? may become defensive. Tell me why you did that? Sympathy Sympathy may be a compassionate I’m so sorry that your leg was amputated. It response however it is not effective as must be terrible. empathy in a therapeutic context. I’m so sorry you lost your mother. Feeling sorry for the patient may impair good judgment by the nurse and anger the client. Defensive responses Suggests criticism is unfounded and Your doctor is quite capable. that the patient has no right to voice I can’t believe that nurse would give you the their opinion. wrong medication. No one here would… Changing the The nurse takes the initiative for the Patient: “I can’t stop thinking about my subject interaction away from the patient, diagnosis.” Nurse: “Let’s go for a walk now.” which is usually due to the nurse’s discomfort. Arguing Denies that the patient’s perception How can you say you didn’t sleep a wink when I was real or accurate. heard you snoring all night? You are not working for the CIA. Downloaded by Kent Spencer Mondido ([email protected]) 4