Chapter 6 Therapeutic Communication Flashcards
Communication
The process that people use to exchange info
Verbal Communication
Consists of words a person uses to speak to one or more listeners
Content
Literal words spoken
Context
Environment, circumstances, situation in which communication occurs
Nonverbal Communication
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
Process
All messages used to give meaning, context to message
Congruent Message
Conveyed when content & process agree
Incongruent Message
When what the speaker says & their behavior do not agree
Tasks of Therapeutic Communication
INTERPERSONAL INTERACTIONS; FOCUS ON
CLIENT’S NEEDS
ENCOMPASSES GOALS THAT FACILITATE THE
NURSING PROCESS NEEDED TO EFFECTIVELY
MEET THE STANDARDS OF CLIENT CARE
Goals of Therapeutic Communication
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
Therapeutic communication is most comfortable when…
… nurse & patient are 3-6 feet apart
Touch
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
Active Listening & Active Observation
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
Meaning
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)
Context
Validation with client findings from verbal and nonverbal information
Assessment focuses on who, what, when, how, and why
Spirituality
Self-awareness of own spiritual beliefs
Need for objectivity and nonjudgmental attitude about client’s beliefs
Cultural Considerations
CULTURAL ASSESSMENT
USE A TRANSLATOR WHO CAN RETAIN ORIGINAL
INTENT WITHOUT INSERTING BIASES
NURSE MUST UNDERSTAND DIFFERENCES IN HOW
VARIOUS CULTURES COMMUNICATE
Therapeutic Communication Goals 2.0
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
Therapeutic Communication Process
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
Empathetic Communication
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
Assertive Communication
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
Non-Therapeutic Communication
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
Community-Based Care
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
