Chapter 9: Therapeutic Communications Flashcards
active listening
nurses focus, respond, and remember what the patient is saying verbally and nonverbally
close ended questions
Questions that can be answered in short or single word responses
cultural filters
in the process of socialization through which we listen to the world around us
debriefing
a critical conversation and reflection regarding an experience that results in growth and learning
double bind messages
-they are characterized by two or more mutually contradictory messages given by a person in power
information communication technology
is a valuable tool for consumers and practicioners to access current psychiatric and medical breakthroughs, diagnoses, and treatment options
mobile medical applications
-apps as tools to monitor, diagnose, treat, and communicate with patients
nontheraputic communication
the tone of voice, emphasis on certain words, and the manner in which a person paces speech
nonverbal behaviors
human actions that have the potential to form meaningful messages
open ended questions
encourage patients to share information about experiences, perceptions, or responses to a situation
patient centered
refers tl the patient as a full partner in care whose values, preferences, and needs are respected
Telehealth technologies
include video conferencing, the internet, phone consultation and counseling, image transmission, and interactive video sessions
therapeutic communication techniques
include words and actions that help to achieve health related goals
verbal communication
consists of all the words a person speaks
communicator
senders and recievers are both considered to be communicators
role is fluid
independent
“communication is not occurring if the receiver is not listening”
message
content and the ideas that are being exchanged
also be nonverbal
channel
the method by which the communication takes place
in person or phone
feedback
the messaging takes place with constant feedback being given by both parties
feedback for one is the message for another
encoding/decoding
individuals encode messages and send to the other and decode messages received from other
encode: develop
decode: determine meaning
context
frames and influences our interactions
environmental noise
serve as a barrier to interaction
disturbs message flow
3 types of context
social
realtional
cultural
social context
stated or unstated rules or norms that guide communicaiton
relational context
interpersonal history
less scripted
cultural context
influence that our culutural identities have on communication
3 types of environmental noise
physical
physiological
psychological
psychical noise
actual noise
physiological noise
biological factors
EX: headache
psychological noise
factors within a persons mind such as not wanting to converse or being preoccupied about finances
guiding principles in communicaiton
clarity
continuity
non directive listening
clarity
ensures that the meaning of the message is accurately understood by both parties
continuity
promotes connections among ideas, feelings, events and themes
non directive listening
allows nurses to provide reflective and nonjudgemental feedback and thereby enables patients to clarify their thoughts
verbal communication
all words a person speaks
nonverbal
how you said it
tone
empasis
pshycial apperance
expressions
posture
be aware of nonverbal cues
how you sit and stand
how is silence benefical
gives person a chance to collect thoughts and response
verbal messages can be called the
content
nonverbal messages are called the
process
double bind messages
mutually contradictory messages, usually given by a person in power
active listening
focus
respond
remember verbal and nonverbal
clarifying techniques
paraphrasing
restating
reflecting
exploring
open ended questions
enourages patients to share info
close ended questions
yes no
good for initial assessment
non therapeutic if used outside of initial assessment
projective questions
“what if”
help people articulate, explore, and identify thoughts and feelings
miracle question
“if you woke up tomorrow and a miracle happened that this issue affecting you went away…”
goal setting question
helps patient see future
broad openings
general
allows patient to take control and give direction to where they want the conversation to go
“what are you thinking about”
“what would you like to talk about”
“where would you like to begin”
broad openings
giving recognition
acknowledging something in patient
recognizing
“I noticed that you dressed and put make up on today”
“you’ve really been participating in groups today”
“it looks like you have put a lot into your journal assignments”
giving recognition
minimal enourgaement
paying attention to what they are saying
“yes”
“I see”
“go on”
minimal encouragement
offering self
offering of yourself/presence
“I would like to spend some time with you”
“ill stay here and sit for awhile”
“you seem upset, would you like to talk”
offering self
accepting
I understand what you are saying
I can imagine how that made you feel
making observations
precursor to giving recognition
saying what you see
noticing behavior and acknowledge it
“you appear anxious”
“I notice you are biting your lips”
“you seem restless”
making observations
validate perceptions
validate that you understand
“you are smiling but I sense you are very angry with me”
“it sounds like that was a really hard time for you, is that correct?”
validate perceptions
exploring
additional detail
specific
“tell me more about that”
“help me understand what that felt like”
“id like to know more about that”
exploring
clarifying
helping to understand
seeking understanding
“im not sure what you mean. could you tell me about that again”
“did these feelings start after the incident happened or were you feeling this way before?”
“give me an example of a time you thought everyone hated you”
clarifying
2nd one is also time and sequencing
“when did you do this?”
“what led up to…”
“how old were you when this happened”
“what happened before”
event in time or sequence
focusing
you have broad topic but you want to focus on something more specific
“lets talk more about your relationship with your father”
“what happens when you feel this way”
“you’ve talked about many things, lets go back to…”
focusing
encouraging the development of a plan
you are giving patient the power to come up with a strategy on their own
“what could you do to let the anger out harmlessly?”
“what do you think you could do next time you feel this way”
encouraging the development of a plan
suggesting collaboration
showing rapport and nurse is on patient side
“perhaps together we can discover what makes you anxious”
“lets try to work through what you are feeling together”
sugesting collaboration
restatment
lets patient hear what they are saying
allows for clarification
“I love my father but I hate him for what he did”
- “you really have mixed feelings about your father because of the abuse”
restatement
summarizing
wrap it up
“during the past hour we have discussed”
“so far we have talked about”
“you have said”
summarizing
types of nontheraptic communication
excessive questioning
giving approval or disapproval (do not pass judgment)
giving advice (not our place to give)
asking why (makes patient defensive)
other tactics to avoid
arguing, challenging
giving false reassurance
interpreting or speculating
probing into sensitive areas pt doesn’t want to talk abt
“sell” patient on accepting treatment
patient attacks
criticizing other staff
barriers to communication
stereotype comments
parroting (mimicking)
changing topic when in depth on another
disagreeing
challenging
what should we do about touch
always ask and use sparingingly
eye contact is based on culture so we should not
use eye contact as a basis to assess for attentiveness
you can sit face to face with patient with or with out table but what should you always do
be eye level with patient
attending behaviors
kinetic communicaiton
vocal quality
proxemics
kinetic communication
nonverbal communication based on body movement
vocal quality is also called
paralanguage
proxemics
study of personal space
levels of proxemics
intimate
personal
social
public
