Chapter 6: Therapeutic Communication Flashcards
1
Q
What is content?
A
Literal words that a person speaks
2
Q
What is context?
A
The environment in which communication occurs and can include time and the physical, social, emotional, and cultural environments
3
Q
What is Process?
A
Denotes all nonverbal messages that the spekaer uses to give meaning and context to the message.
4
Q
Process component of communication requires listeners to
A
observe the behaviors and sounds that accent the words and to interpret the speakers nonverebal behaviors to assess whetehr they agree or disagree
5
Q
A congruent message is conveyed when?
A
When content and process agree
6
Q
Example of congruent message?
A
“I know I haven’t been myself. I need help”. While having a sad facial expression.
7
Q
Exampl eof Incongruent message?
A
Saying “i’m here to get help” but having rigid posture and clenched fists
8
Q
What is therapeutic communication?
A
An interpersonal interaction between the nurse and the client during which the nurse focusese on the client’s specific needs to promote an effective exchange of information
9
Q
Privacy and Respecting Boundaries: What are PRoxemics?
A
Study of distance zones between people during communication. People feel more comfortable in smaller distancing when communicating with someone they know
10
Q
Privacy and Respecting Boundaries: What are the four distance zone?
A
Intimate Zone 0-18 inches
Personal Zone: 18-36 in
Social Zone: 4-12 ft
Public Zone 12-25 ft
11
Q
What is the intimate zone?
A
This space is comfortable for patients with young children, people who mutually desire personal contact, or people whispering. Invasion of this zone produces anxiety
12
Q
What is the personal zone?
A
This distance is comfortable between family and fiends who are talking
13
Q
Privacy and Respecting Boundaries: What is the Social Zone?
A
This distance is acceptable for communication in social, work, and business settings
14
Q
Privacy and Respecting Boundaries: What is the Public Zone?
A
This is an acceptable distance between the speaker and an audience
15
Q
Privacy and Respecting Boundaries: Which culture are comfortable with talking in close proximity?
A
Hispanic, Mediterranean, East Indian, Asian, and Middle Eastern
16
Q
Privacy and Respecting Boundaries: What group may not be comfortable with talking close?
A
European American or African American Heritage
17
Q
Privacy and Respecting Boundaries: What should you say when talking the blood pressure of someone?
A
“Mr Smith, to take your blood pressure I will wrap this aorund your arm and listen with a stethoscope. Is this acceptable for you?”
18
Q
Privacy and Respecting Boundaries: Therapeutic communication interaction is most comfortable when at what distance?
A
3-6 ft
19
Q
Touch: What did Knapp identify?
A
The five types of touch
20
Q
Touch: What are the five types of touch?
A
Functional-Professional Social-Polite Friendship-Warmth Love-Intimacy Sexual-Arousal
21
Q
Touch: What is Functional - Professional touch?
A
Used in examinations or procedures such as when the nurse touches a client to assess skin turgor or massage
22
Q
Touch: What is Social-Polite Touch?
A
Used ing reeting, such as a handshake and the “air kisses” some people use to great acquaintances
23
Q
Touch: What is Friendship-Warmth touch?
A
Involves a hug in greeting , an arm thrown around the shoulder of a good friend, or the backslapping some people use to greet friends and relativevs
24
Q
Touch: What is Love-Intimacy touch?
A
Touch involves tight hugs and kisses between lovers or close relatives
25
Touch: What is sexual-arousal touch?
Used by lovers
26
Active Listening and Observation: Active listening means refrining from other
internal mental activities and concentrating exclusively on what the client says
27
Active Listening and Observation: What is Active Observation?
Means watching the speaker's nonverbal actions as he or she communicates
28
Active Listening and Observation: How did Peplau use observation as the first step in therapeutic interaction?
Observed the client's behavior and guides him or her in giving detailed descriptions of that behavior
29
Active Listening and Observation: TO help patients develop insight into his or her interpersonal skills, what does the nurse do?
Analyzes the information obtained, determined the underlying needs to relate to behvior and connects pieces of information
30
Active Listening and Observation: What is a common misconception of nursing students when listneing?
That they need to have a question instantly ready. But results in nurse not understanding the client's conceerns
31
Using Concrete Messages: When speaking to the client, what kind of words should the nurse use?
Words that are as clear as possible so that the client can understand the message
32
Using Concrete Messages: What kind of words are used in a concrete message?
Words are explicit and need no interpretaion
33
Using Concrete Messages: Example of concrete message?
"What health symptoms caused you to come to the hospital today?"
"When was the last time you took your antidepressant medications?"
Messages are clear, direct.
34
Using Concrete Messages: What are abstract messages?
Are unclear patterns of words that often contain figures of speech that are difficult to interpret.
35
Using Concrete Messages: Example of an Abstract message?
"How did you get here?". This can have many responses!
36
Using Therapeutic Communication Techniques: Example of Accepting response?
Indicates nurse has heard and followed the train of thought. It does no indicate agreement.
"Yes" "I follow what you said"
37
Using Therapeutic Communication Techniques: Broad Openings Examples
Make it explicit that client has lead in interaction.
"Is there something youd like to talk about?"
38
Using Therapeutic Communication Techniques: COnsensual Validation example
Essential that the words being used have the same meaning for both participnts
"Tell me whether my understanding of it agrees with yours."
39
Using Therapeutic Communication Techniques: Encouraging Comparison Examples
Comparing ideas, experiences, or ideas bring many recurring themes. Client benefits fro making these comparasions because might recall past coping strats.
"Was it something like...?"
40
Using Therapeutic Communication Techniques: Encouraging Expression Examples
Nurse asks client to consider people and events in light of his or her own values
"What are your feelings in regard to..?"
41
Using Therapeutic Communication Techniques: Exploring example
When clients deal wiht topics superficially, exploring can help them examine the issue more fully . Problems understood if explored in depth
"Tell me more about that"
42
Using Therapeutic Communication Techniques: Focusing Example
Nurse encourages client to concentrate his or her energies on a single point, which may prevent a multitude of factors or problems from overwhelming client.
"This point seems worth looking at more closely"
43
Using Therapeutic Communication Techniques: Formulating a Plan of Action example
It may be helpful for client to plan in advance what he or she might do in future similar situation
"What could you do to let your anger out harmlessly"
44
Using Therapeutic Communication Techniques: General Leads Example
Indicate that the nurse is listening and following what the client is saying without taking away the initiative for the interaction
"Go on" "And then?"
45
Using Therapeutic Communication Techniques: Giving Information Example
Informing the client of facts increases his or her knowledge about a topic
"My name is " "Visitng hours are"
46
Using Therapeutic Communication Techniques: Giving Recognition Example
Greeting client by name, indicating awareness of change or noting efforts of clients has made
"You've finished your list of things to do"
47
Using Therapeutic Communication Techniques: Making Observations example
Sometimes clients cannot verbalizee or make themselves understood
"Are you uncomfortable when?
48
Using Therapeutic Communication Techniques: Offering Self Example
Nurse can offer his or her presence, interest and desire to understand. It is important that this offer is unconditional
"I'll sit with you awhile"
49
Using Therapeutic Communication Techniques: Placing Event in Time or Sequence example
Putting events in proper sequence helps both parties seem them in prespective
"What seems to lead up to...?"
50
Using Therapeutic Communication Techniques: Presenting Reality Example
When it is obvious that the client is misinterpreting reality, the nurse can indicate what is real
"I see no one else in the room"
51
Using Therapeutic Communication Techniques: Reflecting Example
Reflection encourages the client to recognize and accept his or her own feelings
"Do you think I should tell the doctor..? "Do you think you should?"
52
Using Therapeutic Communication Techniques: Restating Examples
Nurse repeats what the client has said in approximately or nearly the same words
"Im really mad, Im really upset" "You're really mad and upset"
53
Using Therapeutic Communication Techniques: Seeking Information Example
Nurse should seek clarification throughout interactions with clients
"I'm not sure that I follow"
54
Using Therapeutic Communication Techniques: Silence Example
Silence encourages the client to verbalize, provided that it is interested.
Nurse says nothing but continues to maintain eye contact
55
Using Therapeutic Communication Techniques: Suggesting Collaboration Example
Nurse seeks to offer a relationship in which the client can identify problems in living with others, grow emotionally
"Perhaps you and I can discuss and disocver the triggers for your anxiety?
56
Using Therapeutic Communication Techniques: Summarizing Example
Summarizations seeks to bring out the important points of the discussion and seeks to increase awareness and understanding of both participants
"Have I got this straihgt?
57
Using Therapeutic Communication Techniques: Translating into FEelings Example
Often what the client says , when taken literally, seems meaningless or far removed from reality Must concentrate on what they might be feeling
"Are you suggesting you feel lifeless?
58
Using Therapeutic Communication Techniques: Verbalizing The Implied Example
Putting into words what hte client has implied or said indirectly tends to make the dicussions less obscure. Nurse should be direct
"I cant talk to you or anyone.. Its a waste of time. "Do you feel that no one understands?
59
Using Therapeutic Communication Techniques: Voicing Doubt Example
Another meands of responding to distortions of reality is to express doubt. Allows client to become aware
"Isn't that unsual? "Really?"
60
Avoiding Nontherapeutic Communication: Advising Example
Giving advise implies you know whats best
"I think you should"
61
Avoiding Nontherapeutic Communication: Agreeing Example
Approval indicates client is right rather than wrong
"Thats right" "I Agree"
62
Avoiding Nontherapeutic Communication: Belitting FEelings Expressed Example
When the nurse tries to equate the intese and overwhelming feelings the client has expressed to everyone
"I Wish I Was DeaD" "Everybody gets down. I've felt that way myself"
63
Avoiding Nontherapeutic Communication: Challenging Example
Often, nurse believe that if he cacn challenge the unrealistic ideas, client will realise theres no proof.
"But how can you be the presiden tof the united states?"
64
Avoiding Nontherapeutic Communication: Defending Example
Defending what client has critized implies that he or she has no right to express impressions
"I'm your your doctos has the best interests in mind"
65
Avoiding Nontherapeutic Communication: Disagreeing Example
Disagreeing implies client is "wrong".
"Thats wrong" "I don't believe thaT"
66
Avoiding Nontherapeutic Communication: Disapproving Example
Disapproval implies nurse has right to pass judgement on clients thoughts or actions
"That's bad" "I'd rather you wouldn't"
67
Avoiding Nontherapeutic Communication: Giving Approval Example
Saying what client thinks or feels is "good" implies that opposite is bad
"That's good" "I'm glad to hear that"
68
Avoiding Nontherapeutic Communication: Giving Literal Responses Example
Often, client is at a loss to describe his or her feelings . Don't respond to fake hallucinations as if there were a statement of fact
69
Avoiding Nontherapeutic Communication: Indicating the Existence of an External Sourse Example
"What made you think that" implies the client was made or compelled to think in a certain way
70
Avoiding Nontherapeutic Communication: Interpreting Example
Clients thoughts and feelings are their own, and not to be interpreted by nurse for hidden meanin g
"What you really mean is.."
71
Avoiding Nontherapeutic Communication: Introducing an Unrelated Topic Example
Nurse takes the initiative for the interaction away from the client
"I'd like to die" "Did you last evening"
72
Avoiding Nontherapeutic Communication: Making Stereotypes Coments Examples
Social conversations contain many cliches and are meaningless in terms of value
"Its for your own good " "Keep your chin up"
73
Avoiding Nontherapeutic Communication: Probing Example
Probing tends to make clietn feel used or invaded .
"Now tell me abou tthis problem. You know I have to find out"
74
Avoiding Nontherapeutic Communication: Reassuring Example
Attemps to dispel clients anxiety by implying that there is not sufficient reason for concern completely devalue the client's feelings
"Everything will be alright"
75
Avoiding Nontherapeutic Communication: Rejecting Example
When the nurse rejects any topic, closes it off fro exploration
"Lets not discuss"
76
Avoiding Nontherapeutic Communication: Requesitng an Explanation Example
There is a different between asking client to describe what is occuring or has tkane play and asking him/her to explain why
"Why do you thibk that"
77
Avoiding Nontherapeutic Communication: Testing Example
These questions force client to recognize his or her problems
"Do you know what kind of hospital this is?"
78
Avoiding Nontherapeutic Communication: Using Denial Example
Nurse denies clients feelings or seriousness of the siutation by dismissing their comments
"I'm dead" "Don't be silly"
79
Interpreting Signals or Cues: What are cues?
Verbal or nonverbal messages that signal key words or issues for the client.
80
Interpreting Signals or Cues: What are overt cues?
Clear, direct statements of intent such as "I want to die". Message is clear
81
Interpreting Signals or Cues: What are covert cues?
Vague or indirect messages that need interpretation and exploration. "Nothing can help me" can be interpreted in many different ways
82
Interpreting Signals or Cues: When a client uses a cliche, nurse must follow up with
questions to clarify what the client is trying to say
83
Nonverbal Communication Skills: What does this include?
Facial expression, eye contact, space, time, boundaries, and body movements
84
Facial Expression: An expressive face potrays what?
The person's moment-by-moment thoughts, feelings, and needs. These expressions may be evident when the person does not want to reveal his or her emotions
85
Facial Expression: What is an impassive face?
Frozen into an emotionless deadpan expression similar to a mask
86
Facial Expression: What is a confusing facial expression?
One that is the opposite of what the person wants to convey. Person who is verbally expressing sad or angry feelings whhile smiling
87
Body Language: What are closed body positions?
Crossed legs or arms folded across the chest, indidcate the interaction might threaten the listener who is defensive or not accepting
88
Body Language: What shte best accepting body position to be in?
Sit facing the client with both feet on the floor,knees parallel, hands at side of body, and legs uncrossed or crossed only at the ankle
89
Body Language: Open posture demonstates what?
Unconditional positive regard, trust, care, and acceptance.
90
Vocal Cues: A high pitched rapid delivery often indicates
anxiety
91
Vocal Cues: What is circumstantiality?
Use of extraneous words with long, tedious descriptions . Can indicate client is confused about what is important
92
Understanding Spirituality: What is Spirituality?
Client's beliefs about life, health, illness, death and one's relationship to the universe
93
Culture: Culture is al the socially leanred
behaviors, values, beliefs, and customs transmitted downt o each generation
94
Goals: Example of how to begin convo with patient
"Hello Mr Kirk. My name is Kevin. Im your nurse today. I'm here from 7-3:30. I have a few minutes and I see you are ready for the day. I would like to take some time to talk to you if it is convient.
95
Goals: What are some broad openings to begin the coversation?
"What do you like to be called"
"Rain today has been a welcome relief from the past heat"
"So tell me, how are you doing today?"
96
Nondirective Role: What does it mean for nurse to be in a nondirective role?
They will use broad openings and open-ended questions to collect information and to help identify and discuss topics of concern
97
Directive Role: When does a nurse use this?
When a client is suicidal, experiencing a criss, or out of touch with reality
98
Directive Role: What does the nurse ask when in a directive role?
Yes-or-no questions and using problem-solving to help the client develop new coping mechanisms to deal with present issues
99
How to Phrase Questions: Opened ended questions elicit what?
More descriptive information
100
Client's Avoidance of the Anxiety-Producing topic : What can help the nurse determine which topic is more important?
Ask client which issue is most important
Go with new topic bc of given nonverbal messages
Reflect clients behavior
Mentally file away other topic for later
101
Guiding Clients in Problem-Solving and Empoering the Client to Change: What did Satir explain?
How impotant the client's participation is to finding effective and meaningful solutions to problems. If someone else tells them how to solive problems, the client may fear growth and change
102
Guiding Clients in Problem-Solving and Empoering the Client to Change: Nurse who guides client to solve his or her own problems helps client develop
new coping strategies, maintains or increases client self-esteem, adn demonstrates the belief that the client is capable of change
103
Guiding Clients in Problem-Solving and Empoering the Client to Change: Problem-solving process is used when?
When client has difficulty finding ways to solve the problem or when working with a group of people whose divergent viewpoints hunder finding solutions
104
Guiding Clients in Problem-Solving and Empoering the Client to Change:
Steps of problem solving process?
Identify the problem
Brainstorm all possible solutions
Select best alternative
Implement the selected alternative
Evaluate the situation
105
Guiding Clients in Problem-Solving and Empoering the Client to Change: Identifying the problem involves engaging the client in
therapeutic communication
106
Assertive Communication: What is this?
The ability to express positive and negative ideas and feelings in an open, honest ,and direct way. REcognzies rights of both parties and useful in various siutations, like resolving conflicts and solving problems
107
Assertive Communication: Assertive communication can help a person deal with
issues with coworkers, family or friends
108
Assertive Communication: when does asseertive communication work best?
Speaker is calm. Makes specific, factual statements, and focuses on "I" statements
109
Assertive Communication: What are the four types of responses coworkers can have to a fellow workers showing up late to work?
Aggressive
Passive-aggressive
Passive
Assertive
110
Assertive Communication: Example of Aggressive response to fellow worker showing up late?
After saying nothing for several days, nurse jumps on and yells "You're always late! That is so rude! Why can't you be here on time" and leaves room leaving everyone uncomfortable
111
Assertive Communication: Example of Passive-Aggressive response to coworker showing up late?
Coworker says to another nurse "SO nice of her to join us! Aren't we lucky>" Everyone sits in uncomfortable silence
112
Assertive Communication: Example of Passive Response when coworker shows up late
One nurse doesn't say anything at the time but later tells cowoerks "She;s always late. I had to tell her what she missed. I have so much of my own work to do" but doesn't say anything to nurse
113
Assertive Communication: Example of Assertive Response when coworker shows up late?
After report, one nurse says "When you are late, report is disrupted, and I don't like having to repeat information that was already discussed
114
Assertive Communication: Using assertive communication does not guarantee that situation will change, but it does allow the speaker to express
honest feelings in an open and direct way that is still respectful of the other person
115
What is therapeutic communication?
An interpersonal interaction between the nurse and the client during which the nurse focuses on the needs of the client to promote an effective exchange of information
116
Goals of therapeutic communicatio include
establishing rappoprt, actively listening, gaining the client's perspective, exploring the clinet's thoughts and feelings, and guiding the client in problem solving
117
Crucial compoentns of therapeutic communication are
confidentiality, privacy, respect for boundaries, self-disclosure, use of touch , and active listenin g
118
What is proxemics concenred with?
The distance zone between people when they communicate: Intimate, personal, social, public
