Therapeutic communication techniques
- 1. THERAPEUTIC COMMUNICATION TECHNIQUES TECHNIQUES EXAMPLES Using silence Accepting Yes…… Hh hmm….I follow what you said…..…Nodding Giving Recognition Good morning, Mr. S……..You look nice today Offering Self I’ll sit with you a while……..I’m interested in your comfort Giving Broad Openings Is there something you would like to talk about? Where would you like to begin? Offering General Go on Leads/Facilitation Tell me about it Placing the Event in Time or Was this before or after? Sequence When did this happen? Making Observations You seem tense Are you uncomfortable when you. Encouraging Description of What is happening Perception Tell me Encouraging Comparisons Was this something like? Have you had similar symptoms? Restating Client: I can’t sleep, I stay awake all night. Nurse: You have difficulty sleeping? Reflecting Client: Do you think I should tell the doctor? Nurse: Do you think you should. Focusing This symptom seems worth discussing a little bit more. Exploring Tell me more about... Would you describe it more fully? Seeking Clarification I’m not sure that I follow.... What would you say is the main point of what you said? Voicing Doubt Isn’t that unusual?...............Really? Consensus Validation Tell me whether my understanding agrees with yours? Collaboration Perhaps together we can figure this out. Summarizing Have I got this straight? You’ve said that During the past 15 minutes we’ve discussed. 1
- 2. TECHNIQUES FOR COMMUNICATING WITH ELDERLY CLIENTS I. Factors Influencing Communication with the Elderly Client Factors A. Anxiety: Many elderly clients may function continually at a high level of anxiety. Thus, the increased stress of a new situation may lead to intense arousal, impairing the elderly person’s ability to communication effectively. B. Sensory Deprivation: Hearing loss is a widespread problem among the elderly. It’s affects men more than women and occurs in some 30% of all elderly. Hearing loss is potentially the most difficult sensory loss for the elderly client. Although 80% of the elderly have fair to adequate vision, some visual problems may occur. C. Cautiousness: Older clients tend to make few errors of commission but are likely to make errors of omission. When taking a history, the nurse must be aware that elderly clients may omit important aspects of their illnesses. Elderly clients take longer to respond to inquires. D. Persistent Themes: The elderly client may concentrate on particular themes: Somatic Concerns: Clients may spend much time complaining of ailments or recounting detailed histories of bodily functions. At a time when friends and loved ones have died and sensory input is decreased, the body, in many ways, keeps the client company. It is, therefore quite usual for the elderly client to be somatically oriented. Loss Reactions: The elderly client may spend considerable time discussing the many losses experienced in later life. These include loss of friends and loved ones, loss of activities, and loss of self esteem. Life Review: There is tendency in the elderly to reflect and reminisce. This is a normal process brought about by disillusion and realization that death is approaching. Fear of Losing Control: Many elderly clients agonize over the loss of physical and mental functions, including physical strength, bowel and bladder control, motor functions, and especially, the ability to regulate one’s thoughts and emotions. One of the greatest fears of late life is the fear of “going crazy”. Death: The elderly are not, as a rule, obsessed with approaching death. It nevertheless, is a frequent topic of conservation. The major fear is of being alone at the end of life. 2
- 3. Nurse Factors: A. Attitudes toward the Elderly: It is quite common to find fears of aging and death among members of our youth oriented society. The recognition of such fears and of the nurse’s personal feelings about these issues is of utmost importance in establishing effective communication with the elderly. B. Lack of Understand: The nurse must attempt to separate myths about aging from reality. For example, the labeling and stereotyping of the elderly may be a significant barrier to communication. The elderly are especially sensitive to being labeled “senile”, “mentally ill”, or “hypochondriac”. The nurse should try to empathize with the elderly client. Putting your self in the other person’s shoes is ability not easily taught by text books and can only be learned through personal experiences. II. Techniques of Effective Communication Approach the Elderly Client with Respect: The nurse should knock before entering the client’s room and approach the client from the front. Greet the client by surname, (Mr. Smith, Mrs. Rose) rather than by given name (Johnny, Mary), unless the client wishes to be addressed by a given name. Position Yourself Near the Elderly Client: The nurse should be close enough to the client to be able to reach out and touch the client if desired. The most comfortable arrangement of chairs for both parities is at a 45 degree angle to each other. If possible, chairs should be the same height and the nurse should not stand or walk during the conservation. Speak Clearly and Slowly: The elderly client may have a hearing problem or may not understand the nurses’ accent. Clarity of speech and the use of simple sentences are most effective in communicating with an elderly client. Inquire Actively and Systematically into the Problem Presented: The nurse should inquire into common physical symptoms of later life (such as visual and auditory defects, falls, and weight loss) and typical psychosocial problems (death of a loved one, change in living arrangements, recent retirement, financial setback, feelings of decreased self esteem, hopelessness, and anxiety). Pace the Interview: The elderly client must be given enough time to respond to the nurses questions. The elderly are not, as a rule, uncomfortable with silences, which give them an opportunity to formulate answers to questions, and to elaborate on certain points. A slow and relaxed pace in the interview will do much to decrease anxiety. Pay Attention to Nonverbal Communication: The nurse should be alert for changes in facial expression, gestures, postures, and touch as auxiliary methods of communication in the elderly. These nonverbal signs can provide considerable information about conditions such as depression or anxiety. Touch: Touch may also be an effective way to relax and make contact with the elderly client. As a rule, the elderly are less inhibited about physical touch. Holding the client’s hand or resting your hand on his arm may be very reassuring. 3
- 4. Be Realistic but Hopeful: Nurses who work with the elderly often deny the problems of later life. But neither the client nor the nurse believe phrases like “You’ll live to be a hundred”, or “It’s nothing to worry about”, and the nurse should avoid using them. The nurse should never abandon all hope for an elderly client, but should work in the here and now. Avoiding unrealistic expectations, three pain free days may be most rewarding to the client dying of cancer, a fact too often overlooked. 4
- 5. TOPIC: TECHNIQUES FOR COMMUNICATING WITH CHILDREN Age Group Characteristics Communication Techniques Toddlers Limited vocabulary & Make explanations brief and clear. Use child’s own verbal skills vocabulary words for basic are activities (urinate = pee pee, tinkle), learn and use self name of child. Get to know child first before approaching child. Show you can be a friend with mommy. Speaks in phases Rephrase child’s message in a simple complete sentence: avoid baby talk. Kinesthetic Allow ambulation when possible. Put child in a wagon if child is not mobile. Struggling with issues of Allow child some control. Reassure child if he or autonomy and control she displays some regressive behavior. (Example: If child wets his pants, say, “We will get a dry pair of pants and let’s find something fun to do”). Allow child to express anger and to protest about his care (Example: Say “it’s OK to cry when you are angry or hurt). Allow to sit up or walk, as often as possible and as soon as possible after intrusive or hurtful procedures, say, “It’s all over and we can do something more fun”). Fear of Bodily Injury Show hands (free of hurtful items) and say. “There is nothing to hurt you. I came to play/talk. Egocentrism Allow child to be self oriented and accepted. Use distraction if another child wants the same item or toy rather than expect child to share. Direct Questions Use non-directive approach. Sit down and join the parallel play of child. Separation Anxiety Accept protesting when parents leave. Hug, rock the child, and say “You miss mommy and daddy, They miss you too.” Preschoolers Speaks in sentences but Use simple vocabulary; avoid lengthy unable to comprehend explanations. Focus on the present. Use play abstract ideas. therapy and drawings. Unable to tolerate direct Use some eye contact. Sit or stoop and use slow, eye to eye contact. soft tone of voice. Short attention span and Use play therapy. Use sensory data. Use music. imaginative stage Concrete sense of humor Tell corny jokes and laugh with child Need for control Provide for many choices. “Do you want to get dressed now or after breakfast?” 5
- 6. School Age Developing ability to Include child in concrete explanations about comprehend condition, treatment, protocols. Use draw a person. Use sensory information in giving explanations. Increased responsibility Reinforce basic care activities in teaching. for health care. Increased need for Respect privacy; knock on door before entering privacy. room: tell client when and for what reasons you will need to return to his/her room. Early Increased comprehension Verbalize issues about treatment protocols Adolescent about possible negative requiring giving up immediate gratification for threats to life or body long term gain. Explore alternative options. integrity, yet some difficulty in adhering to long term goals. Confidentiality Reassure about confidentiality of your discussion, but clearly state limits of confidentially. Struggling to establish Allow participation in decision making. identify and be Actively listen. Accept regression. independent Avoid judgmental approach. Use clarifying and qualifying approach. Beginning to demonstrate Use abstract thinking, but look for abstract thinking. nonverbal clues that indicate lack of understanding. Uses colloquial language Touch your dialogue with the use of some of client’s own words. Sexual Awareness and Offer self and willingness to listen. maturation Provide value free, accurate information. J. Ruth, MSN, RN University of North Carolina. 1987 6