Therapeutic Communication
1 like1,000 views
Therapeutic communication is an interpersonal interaction between a nurse and client that focuses on understanding and addressing the client's needs. The goals are to establish a relationship, identify concerns, assess perceptions, facilitate expression of emotions, teach self-care skills, recognize needs, and guide the client towards a plan of action. Therapeutic communication uses both verbal and nonverbal elements, and techniques include active listening, making observations, exploring topics in depth, focusing on key points, and formulating plans with the client. Conditions like values, culture, age, and environment can all affect communication between individuals.
Therapeutic Communication
- 1. Therapeutic Communication Dr. James Malce Alo, RN,MAN,MAP,PHD
- 2. WHAT IS THERAPEUTIC COMMUNICATION?  Interpersonal interaction between the nurse and client during which the nurse focuses on the client’s specific needs to promote an effective exchange of information.
- 3. Therapeutic Communication 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. Skilled use helps the nurse understand and emphatize with the client’s experience
- 4. Goals of Therapeutic Communication  Establish a therapeutic nurse-client relationship.  Identify the most important client concern at that moment (the client-centered goal).  Assess the client’s perception of the problem as it unfolds. This includes detailed actions (behaviors and messages) of the people involved and the client’s thoughts and feelings about the situation, others, and self.
- 5. Facilitate the client’s expression of emotions. Teach the client and family necessary self-care skills. Recognize the client’s needs. Guide the client toward identifying a plan of action to a satisfying and socially acceptable situation.
- 6. Communication ď‚› is the process that people use to exchange information. ď‚› Messages are simultaneously sent and received on two levels: 1) verbally through the use of words and 2) nonverbally by behaviors that accompany the words (Balzer Riley, 2000).
- 7. Verbal communication ď‚› consists of the words a person uses to speak to one or more listeners. 1. Content - the literal words that a person speaks. 2. Context is the environment in which communication occurs and can include the time and the physical, social, emotional, and cultural environment (Weaver, 1996).
- 8. Nonverbal communication  is the behavior that accompanies verbal content such as body language, eye contact, facial expression, tone of voice, speed and hesitations in speech, grunts and groans, and distance from the listener.  Nonverbal communication can indicate the speaker’s thoughts, feelings, needs, and values that the speaker acts out mostly unconsciously.
- 9. Congruent message  is when content and process agree.  For example, a client says, “I know I haven’t been myself. I need help.” She has a sad facial expression and a genuine and sincere voice tone.
- 10. Incongruent message  content and process disagree—when what the speaker says and what he or she does do not agree.
- 11. Therapeutic communication can help nurses to accomplish many goals:  Establish a therapeutic nurse– client relationship  Identify  Assess  Facilitate  Teach  Recognize  Guide
- 12. Proxemics ď‚› is the study of distance zones between people during communication. ď‚› four distance zones: ď‚› Intimate zone (0 to 18 inches between people): parents with young children. ď‚› Personal zone (18 to 36 inches): family and friends who are talking. ď‚› Social zone (4 to 12 feet): in social, work, and business settings. ď‚› Public zone (12 to 25 feet): speaker and an audience, small groups, and other informal functions (Hall, 1963).
- 13. Touch ď‚› Functional-professional touch is used in examinations or procedures. ď‚› Social-polite touch is used in greeting, such as a handshake. ď‚› Friendship-warmth touch involves a hug in greeting, an arm thrown around the shoulder of a good friend, or the back slapping some men use to greet friends and relatives. ď‚› Love-intimacy touch involves tight hugs and kisses between lovers or close relatives. ď‚› Sexual-arousal touch is used by lovers.
- 15. Active listening ď‚› means refraining from other internal mental activities and concentrating exclusively on what the client says.
- 16. Active observation  means watching the speaker’s nonverbal actions as he or she communicates
- 17. Conditions Affecting Communication ď‚› Values ď‚› Attitudes ď‚› Beliefs ď‚› Perceptions ď‚› Culture or Religion ď‚› Social Status ď‚› Gender ď‚› Age or developmental level ď‚› Environment
- 18. Enhancing Communication  Silence  Support/reassurance  Sharing Observations  Acknowledge feelings  Broad – open ended statements  Information giving  Interpretation  Restating  Reflecting  Clarification  Confrontation  Offering Alternatives  Voicing doubt  Role-playing  Use of Humor – use cautiously/discretel y
- 20. THERAPEUTIC COMMUNICATION TECHNIQUES TCT Examples Rationale Accepting— indicating reception “Yes.” “I follow what you said.” Nodding An accepting response indicates the nurse has heard and followed the train of thought. It does not indicate agreement but is nonjudgmental. Facial expression, tone of voice, and so forth also must convey acceptance or the words will lose their meaning.
- 21. Broad openings— allowing the client to take the initiative in introducing the topic “Is there something you’d like to talk about?” “Where would you like to begin?” Broad openings make explicit that the client has the lead in the interaction. For the client who is hesitant about talking, broad openings may stimulate him or her to take the initiative. Consensual validation— searching for mutual understanding, for accord in the meaning of the words “Tell me whether my understanding of it agrees with yours.” “Are you using this word to convey that . . . ?” For verbal communication to be meaningful, it is essential that the words being used have the same meaning for both (all) participants. Sometimes words, phrases, or slang terms have different meanings and can be easily misunderstood.
- 22. Encouraging comparison— asking that similarities and differences be noted “Was it something like . . . ?” “Have you had similar experiences?” Comparing ideas, experiences, or relationships brings out many recurring themes. 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 survived a similar situation Encouraging description of perceptions— asking the client to verbalize what he or she perceives “Tell me when you feel anxious.” “What is happening?” “What does the voice seem to be saying?” Encouraging the client to describe ideas fully may relieve the tension the client is feeling, and he or she might be less likely to take action on ideas that are harmful or frightening.
- 23. Encouraging expression— asking client to appraise the quality of his or her experiences “What are your feelings in regard to . . . ?” “Does this contribute to your distress?” consider people and events in light of his or her own values. Doing so encourages the client to make his or her own appraisal rather than accepting the opinion of others. Exploring—delving further into a subject or idea “Tell me more about that.” “Would you describe it more fully?” “What kind of work?” help them examine the issue more fully. Any problem or concern can be better understood if explored in depth. If the client expresses an unwillingness to Explore a subject, however, the nurse must respect his or her wishes.
- 24. Focusing— concentrating on a single point “This point seems worth looking at more closely.” “Of all the concerns you’ve mentioned, which is most troublesome?” encourages the client to concentrate his or her energies on a single point, which may prevent a multitude of factors or problems from overwhelming the client. It is also a useful technique when a client jumps from one topic to another. Formulating a plan of action— asking the client to consider kinds of behavior likely to be appropriate “What could you do to let your anger out harmlessly?” “Next time this comes up, what might you do to handle it?” helpful for the client to plan in advance what he or she might do in future similar situations. Making definite plans increases the likelihood that the client will cope more effectively in a similar situation.
- 25. General leads— giving encouragement to continue “Go on.” “And then?” “Tell me about it.” indicate that the nurse is listening and following what the client is saying without taking away the initiative for the interaction. Giving information— making available the facts that the client needs “My name is .” “Visiting hours are . . .” “My purpose in being here is .” Informing the client of facts increases his or her knowledge about a topic or lets the client know what to expect. Giving recognition— acknowledging, indicating awareness “Good morning, Mr. S . . .” “You’ve finished your list of things to do.” “I notice that you’ve combed your hair.” 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, as an individual.
- 26. Making observations— verbalizing what the nurse perceives “You appear tense.” “Are you uncomfortable when . . . ?” “I notice that you’re biting your lip.” Sometimes clients cannot verbalize or make themselves understood. Or the client may not be ready to talk. Offering self— making oneself available “I’ll sit with you awhile.” “I’ll stay here with you.” “I’m interested in what you think.” The nurse can offer his or her presence, interest, and desire to understand. Placing event in time or sequence— clarifying the relationship of events in time “What seemed to lead up to . . . ?” “Was this before or after . . . ?” “When did this happen?” Putting events in proper sequence helps both the nurse and client to see them in perspective.
- 27. Presenting reality— offering for consideration that which is real “I see no one else in the room.” “That sound was a car backfiring.” “Your mother is not here; I am a nurse.” When it is obvious that the client is misinterpreting reality, the nurse can indicate what is real.
- 28. Thank YOU! - Dr. James Malce Alo