THERAPEUTIC COMMUNICATION Flashcards
Is the process that people use to exchange information
Communication
What are the 2 forms of communication?
- Verbal Communication
- Non-Verbal Communication
-Consists of the words a person uses to speak or one or more listeners
- Words consist of the object and concept being discussed
Verbal Communication
Behavior that accompanies verbal contents such as body language, eye contact, facial expression, tone of voice, speed and hesitations in speech, grunts and groans, and distance from listeners
Non-Verbal Communication
is an interpersonal interaction between the nurse and the client during
which the nurse focuses on the client’s specific needs to promote and effective exchange of
information (Videbeck, 2020).
Therapeutic Communication
Elements of Therapeutic Communication
- Privacy and Respecting Behaviors
- Touch
- Active Listening and Active Observation
Elements of Therapeutic Communication
Means freedom from interference or intrusion. It is the right to be let alone. Privacy is
desirable but not always possible in therapeutic communication.
Privacy and Respecting Boundaries
What’s the nursing responsibility of Privacy and Respecting boundaries?
Ensure appropriate setting for therapeutic
communication.
o Conduct interview in a conference room.
o Informal conversations at the end of the hall or in a quiet corner of a lobby.
Part of Privacy and Respecting Boundaries where it is the study of distance zones between people during communication
Proxemics
Distance Zones of Proxemic
Intimate zone (0-18 inches between people)
▪ Comfortable for parents with young children
▪ People who mutually desire personal contact
▪ Invasion is threatening and produces anxiety
Personal zone (18-36 inches)
▪ Appropriate for normal conversation between family and friends
Social zone (4- 12 feet)
▪ Communication in social, work, and business setting
Public zone (12- 25 feet)
-Appropriate distance between speaker and audience, or small groups
-When the nurse must invade the intimate zone or personal zone, he or she should always
ask the client’s permission. He or she should ask permission in a yes/no format, so the
client’s response is clear.
- The therapeutic communication interaction is most comfortable when the nurse and the
client are 3 to 6 feet apart.
Touch
Used in examinations or procedures
Functional- professional touch
Touch
-Used in greeting someone
- Used when a gentle hand guides someone in the correct direction
Social-Public Touch
Touch
-Hug in greeting
-Arm thrown around the shoulder of a good friend
-Backslapping used by some men to greet close friends
Friendship-warm touch
Touch
-Tight hugs and kisses between lovers or close relatives
Love-intimacy touch
Touch
-French kiss
-Used by lovers
Sexual-arousal touch
Additional information about TOUCH
-Touching a client can be comforting and supportive when it is welcome and permitted,
otherwise it becomes inappropriate form of touch
-When a staff member is going to touch a client while performing nursing care, he or she
must verbally prepare the client before starting the procedure
-Caution must be made when dealing with clients with history of abuse or with paranoia
means refraining from other internal mental activities and
concentrating exclusively on the client is saying
Active Listening
means watching the speaker’s non-verbal actions as he or she
communicates.
Active Observation
An important factor in verbal communication skills that convey words that are explicit and need no interpretation.
Concrete messages
Identify the sentences if it is a Concrete or Abstract
“What health symptoms caused you to come to the hospital today?”
Concrete Messages
Identify the sentences if it is a Concrete or Abstract
“Why are you in the hospital today?’
Abstract Messages
Verbal Communications Skills
It is an unclear pattern of words that often contain figures of speech that are difficult to interpret. They require the speaker to interpret what the speaker is asking
Abstract Messages
Identify the sentences if it is a Concrete or Abstract
“Your clinical performance has to improve”
Abstract
“To administer medications tomorrow, you will have to be able to calculate dosages
correctly by the end of today’s class.”
Concrete
What are the Therapeutic Communication Techniques?
-Broad Openings
- Offering self
-Offering general leads
- Making Observations
- Presenting reality
-Reflecting
-Restating
-Exploring
-Seeking Clarification/Information
-Verbalizing the implied
-Using silence
-Allowing the client to take the initiative in introducing the topic.
-Emphasizes the importance of the client’s role in the interaction.
Broad Openings
“Where would you like to begin?”
“What would you like to talk about today?
“Tell me what you are thinking.”
Broad Openings
-Making oneself available on an unconditional basis
-Increases client’s self- worth.
Offering Self
“I will sit with you for a while.”
“I’m interested in what you think.”
Offering self
Giving encouragement to continue
Offering General Leads
What type of therapeutic communication technique is this?
“Go on.”
“Yes, I see.”
“And what happened after that?”
Offering general leads
-Verbalizing what is observed or perceived
- Encourages the client to recognize specific behaviors and compares perception with the nurse
Making Observations
What type of therapeutic communication technique is this?
“You appear tense.”
“You are pacing a lot.”
“You seem uncomfortable when you…”
Making Observations
-Offering for consideration that what is real.
-When the client has a misperception of the environment, the nurse defines reality or indicates his
or her perception of the situation for the client.
Presenting Reality
What type of Therapeutic Communication Technique is this?
“I know that the voices seem real to you, but I do not hear any voices.”
“The sound of a telephone ringing is coming from the TV show.”
“There is no one else in the room.”
Presenting Reality
-Directing client actions, thoughts, and feelings back to the client
-Questions and feelings are referred back to the client so that they may be recognized and
accepted, and so that the client may recognize that his or her point of view has value.
-A good technique when the client asks the nurse for advice.
Reflecting
What type of Therapeutic Communication Technique is this?
Client: “Do you think I should tell my doctor?”
Nurse: “Do you think you should?”
C: “What do you think I should do about my wife’s drinking problem?”
N: “What do you think you should do?”
C: “My brother spends all of my money and has the nerves to ask for more.”
N: “This causes you to feel angry?”
C: “My sister won’t help a bit towards my mother’s care. I have to do it all!”
N: “You feel angry when she doesn’t help.”
Reflecting
-Repeating the main idea expressed
- This lets the client know whether or not an expressed statement has been understood and gives him or her the chance to continue, or to clarify if necessary
Restating
-Delving further into a subject, idea, experience, or relationship.
-Especially helpful with clients who tend to remain on a superficial level of communication.
However, if the client chooses not to disclose further information, the nurse should refrain from
pushing or probing in an area that obviously creates discomfort.
Exploring
-Seeking to make clear that which is not meaningful or that which is vague
-Searching for mutual understanding
Seeking Clarification/Information
What type of Therapeutic Communication Techniques is this?
“I’m not sure that I follow.”
“Tell me if my understanding agrees with yours.”
Seeking Clarification/Information
-Voicing what the client has hinted at or suggested
▪ Putting into words what the client has only implied or said indirectly.
▪ Can also be used with the client who is mute or is otherwise experiencing impaired verbal communication.
Verbalizing the implied
What type of therapeutic communication technique is this?
C: “I can’t talk to you or anyone. It’s a waste of time.”
N: “Do you feel that no one understands?”
Verbalizing the implied
-Absence of verbal communication, which provides time for the client to put thoughts or feelings into words,
to regain composure, or to continue talking.
▪ Gives the client the opportunity to collect and organize thoughts, to think through a point, or to consider
introducing a topic of greater concern than the one being discussed
Using Silence
are responses that cut off communication and make it more difficult
for the interaction to continue.
Avoiding Non-Therapeutic Communication
Types of Avoiding Non-Therapeutic Communication
-Advising
- Agreeing/Disagreeing
-Belittling feelings expressed
- Defending
-Introducing unrelated topic
-Interpreting
-Making stereotyped comments
-Probing
-False reassurance
-Requesting an Explanation
-Using Denial
-Telling the client what to do or how to behave implies that the nurse knows what is best and that the client
is incapable of any self-direction.
▪ It nurtures the client in the dependent role by discouraging independent thinking.
Advising
-Indicating accord with or opposition to the client’s ideas or opinions.
▪ Implies that the nurse has the right to pass judgment on whether the client’s ideas or opinions are “right” or
“wrong.”
Agreeing/Disagreeing
-Misjudging the degree of client’s discomfort.
▪ This causes the client to feel insignificant or unimportant.
Belittling Feelings Expressed
▪ Attempting to protect something or someone from a verbal attack.
▪ To defend what the client has criticized is to imply that he or she has no right to express ideas, opinions, or
feelings
Defending
▪ Changing the subject
▪ The nurse takes the initiative for the interaction away from the client. This usually happens because the
nurse is uncomfortable, doesn’t know how to respond, or has a topic he or she would rather discuss.
Introducing Unrelated Topic
▪ Asking to make conscious that which is unconscious.
▪ Telling the client the meaning of his or her experience.
▪ The nurse must leave interpretation of the client’s behavior to the psychiatrist. The nurse has not been
prepared to perform this technique, and in attempting to do so, may endanger other nursing roles with the
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Interpreting
▪ Offering meaningless cliches and trite expressions.
▪ When the nurse makes empty conversation, it encourages a like response from the client.
Making Stereotyped Comments
▪ Persistent questioning of the client
▪ Pushing for answers to issues the client does not wish to discuss. This causes the client to feel used and
valued only for what is shared with the nurse and places the client on the defensive.
Probing
Indicating there is no reason for the anxiety or other feelings of discomfort.
False Reassurance
▪ Asking the client to provide reasons for thoughts, feelings, behaviors, events.
▪ Asking “why” a client did something or feels a certain way can be very intimidating.
▪ Implies that the client must defend his or her behavior or feelings.
Requesting an Explanation
▪ Refusing to admit that a problem exists.
▪ Denying that a problem exists blocks discussion with the client and avoids helping the client identify and
explore areas of difficulty.
Using Denial
What type of Avoiding Non-Therapeutic Communication is this?
“I think you should…”
“Why don’t you…”
Advising
What type of Avoiding Non-Therapeutic Communication is this?
“That’s right. I agree.”
“I don’t believe that.”
Agreeing/Disagreeing
What type of Avoiding Non-Therapeutic Communication is this?
C: “I have nothing to live for. I wish I were dead.”
N: “Everybody gets down in the dump at times. I feel that way sometimes.”
Belittling Feelings Expressed
What type of Avoiding Non-Therapeutic Communication is this?
C: “I’m not quite sure about Dr. Smith. He seems off to me.”
N: “Dr. Smith is a fine surgeon. He graduated top of his class.”
Defending
What type of Avoiding Non-Therapeutic Communication is this?
C: “I’d like to die.”
N: “Did you have visitors last evening?
Introducing unrelated topic
What type of Avoiding Non-Therapeutic Communication is this?
“What you really mean is…”
“So unconsciously you are saying…”
Interpreting
What type of Avoiding Non-Therapeutic Communication is this?
“It’s for your own good.”
“Just have a positive attitude and you’ll be better in no time.”
Making Stereotyped Comments
What type of Avoiding Non-Therapeutic Communication is this?
“Tell me about how you feel toward your mother now that she is dead.”
Probing
What type of Avoiding Non-Therapeutic Communication is this?
“Everything will be alright.”
“You’re coming along just fine.”
False Reassurance
What type of Avoiding Non-Therapeutic Communication is this?
“Why do you think that?”
“Why do you feel that way?”
“Why did you do that?”
Requesting an Explanation
What type of Avoiding Non-Therapeutic Communication is this?
C: “I am nothing.”
N: “Of course you are something. Everybody is something.”
Using Denial
