Chapter 6 Therapeutic Communication

Question 1

Communication

Answer 1

The process that people use to exchange info

Question 2

Verbal Communication

Answer 2

Consists of words a person uses to speak to one or more listeners

Question 3

Content

Answer 3

Literal words spoken

Question 4

Context

Answer 4

Environment, circumstances, situation in which communication occurs

Question 5

Nonverbal Communication

Answer 5

The behavior that accompanies verbal content such as:
- Body language
- Eye contact
- Facial expressions
- Tone of voice
- Vocal speed & hesitations
- Grunts & groans
- Listening distance from others

Question 6

Process

Answer 6

All messages used to give meaning, context to message

Question 7

Congruent Message

Answer 7

Conveyed when content & process agree

Question 8

Incongruent Message

Answer 8

When what the speaker says & their behavior do not agree

Question 9

Tasks of Therapeutic Communication

Answer 9

INTERPERSONAL INTERACTIONS; FOCUS ON
CLIENT’S NEEDS

ENCOMPASSES GOALS THAT FACILITATE THE
NURSING PROCESS NEEDED TO EFFECTIVELY
MEET THE STANDARDS OF CLIENT CARE

Question 10

Goals of Therapeutic Communication

Answer 10

Establish therapeutic nurse-client relationship

Implement interventions to address client’s needs

Recognize client’s needs

Teach client and family the necessary self-care skills

Facilitate client’s expression of emotions

Identify the most important client’s concerns; assess client’s perceptions

Guide client toward acceptable solutions
- Motivational interviewing

Question 11

Therapeutic communication is most comfortable when…

Answer 11

… nurse & patient are 3-6 feet apart

Question 12

Touch

Answer 12

Types: functional-professional, social-polite, friendship-warmth, love-intimacy, sexual-arousal

Comforting and supportive when welcome and permitted

Can be possible invasion of intimate and personal space

The nurse must evaluate use of touch based on the client’s preferences, history, and needs.

Nurse may find touch supportive, client may not

Question 13

Active Listening & Active Observation

Answer 13

Active Listening: Concentrating exclusively on what patient says

Active Observation: Watching nonverbal actions as speaker communicates

Help the Nurse
- Recognize the most important issue
- Know what questions to ask
- Use therapeutic communication techniques
- Prevent jumping to conclusions
- Objectively respond to message

Question 14

Meaning

Answer 14

Messages often contain more meaning than just spoken word

Ex) “I’m so tired, I just want to die” (they do not actually want to die)

Question 15

Context

Answer 15

Validation with client findings from verbal and nonverbal information

Assessment focuses on who, what, when, how, and why

Question 16

Spirituality

Answer 16

Self-awareness of own spiritual beliefs

Need for objectivity and nonjudgmental attitude about client’s beliefs

Question 17

Cultural Considerations

Answer 17

CULTURAL ASSESSMENT

USE A TRANSLATOR WHO CAN RETAIN ORIGINAL
INTENT WITHOUT INSERTING BIASES

NURSE MUST UNDERSTAND DIFFERENCES IN HOW
VARIOUS CULTURES COMMUNICATE

Question 18

Therapeutic Communication Goals 2.0

Answer 18

Establishing rapport

Actively listening

Gaining in-depth understanding of client’s perception of issue
- Avoid asking “why” questions

Being empathetic

Exploring client’s thoughts and feelings

Facilitating client’s expression of thoughts and
feelings

Guiding client in developing problem-solving skills

Promoting client’s evaluation of solutions

Question 19

Therapeutic Communication Process

Answer 19

Identify major concern

Nondirective role- broad openings, open-ended questions

Directive role – yes/no questions if client w/ suicidal thoughts, in crisis, or out of touch with reality
- “Are you having suicidal thoughts?”

Use open-ended versus yes / no questions

Phrase questions properly

Use “think” vs. “feel”
- How do you “feel” about that: Elicits an emotional response
- Using “think” elicits a cognitive response

Active listening – ask open-ended questions & build on client’s responses

Techniques include placing an event in time or sequence

Ask for clarification

Address client’s avoidance of anxiety-producing topic

Guide the client in problem-solving and change

Help the client explore possibilities

Client’s participation is key

Avoid inserting own beliefs

Question 20

Empathetic Communication

Answer 20

Recognizing when emotions or concerns may be present but not directly expressed
- Look for nonverbal cues

Inviting exploration of unexpressed feelings or concerns

Non-verbally or verbally acknowledging feelings or concerns so the person feels understood

Question 21

Assertive Communication

Answer 21

Express feelings & ideas in an open, honest, direct way

Make calm, specific, factual statements

Focus on “I” statements

Rehearse responses

Responses may be aggressive, passive–aggressive, passive, or assertive

Question 22

Non-Therapeutic Communication

Answer 22

Failing to listen

Being judgmental

Reassuring: “Everything is going to be okay”-> not creating a safe space for the client to express & feel the emotions

Rejecting

Defending

Giving advice

Making stereotyped responses

Changing topics

Question 23

Community-Based Care

Answer 23

Nurses increasingly care for high-risk clients in homes

Families becoming more responsible for primary prevention

Therapeutic communication techniques & skills are essential

Need ↑ self-awareness, cultural knowledge, sensitivity to beliefs, behaviors, feelings of others

Collaborate with client and family as well as other health care providers