THERAPEUTIC COMMUNICATION Flashcards
is a two-way process between two or more individuals. It is an interaction between two or more people that involves the exchange of information between a sender and a receiver.
COMMUNICATION
The product of communication is the __________, which is interpreted by the receiver.
MESSAGE
In psychiatric nursing, ________ is one of the most important tools that nurses can use for building trust, developing therapeutic relationship, providing support and comfort, encouraging growth and change, and implementing patient education.
therapeutic communication
_________– in psychiatric nursing, the nurse, using verbal and nonverbal communication, is the primary therapeutic agent with psychiatric patients.
Therapeutic use of self
COMMUNICATION ARE INFLUENCED BY THE FOLLOWING FACTORS:
- Environmental Considerations
- Physical Considerations
- Kinesics Considerations
___________ – is a process in which the nurse consciously influences a CLIENT or helps the client to a better understanding through a verbal or non -verbal communication. It involves the use of specific strategies that encourage the patient to express feelings and ideas and that they convey acceptance and respect.
THERAPEUTIC COMMUNICATION
__________ – the GOAL is to increase self-worth or decrease psychological distress by collecting information to determine the illness, assessing and modifying the behavior, and providing health education.
SIGNIFICANCE
PRINCIPLES OF THERAPEUTIC COMMUNICATION:
● Concreteness
● Honesty
● Assistance
● Acceptance
● Interest
● Respect
● Empathy
● Protection
_______-caregivers are specific and clear when they communicate.
Concreteness
_________- consistent and open. They communicate with the client as authentic person.
Honesty
– commit time and energy to therapeutic relationships. Convey their presence.
Assistance
– it is only when people feel accepted for what they are that they will consider change.
Acceptance
– show or express the desire to know the other person.
Interest
– communicate willingness to work with client and accept their ideas, feelings and rights.
Respect
– understand feelings of patients.
Empathy
– always ensure client’s safety.
Protection
THERAPEUTIC TECHNIQUES:
- Offering self
- Active listening
- Exploring
- Giving broad openings
- Silence
- Stating and observing
- Encouraging comparisons
- Identifying themes
- Summarizing
- Placing the event in time and sequence
- Voicing doubt
- Encouraging descriptions of perceptions
- Presenting reality or confronting
- Seeking clarification
- Verbalizing the implied
- Reflecting
- Restating
- General leads
- Asking question
- Empathy
- Focusing
- Interpreting
- Encouraging Evaluation
- Suggesting Collaboration
- Encouraging goal setting
- Encouraging formulation of a plan of action
- Encouraging decisions
- Encouraging consideration of options
- Giving Information
- Limit Setting
- Supportive confrontation
- Role Playing
- Rehearsing
- Feedback
- Encouraging evaluation
- Reinforcement
● Making self-available and showing interest and concern
● “I will walk with you.”
Offering Self
● Paying close attention to what the patient is saying by observing both verbal and non-verbal cues.
● Maintaining eye contact and making verbal remarks to clarify and encourage further communication.
Active Listening
● “Tell me more about your son.”
Exploring
● What do you want to talk today?
Giving Broad Openings
● Planned absence or verbal remarks to allow patient and nurse to think over what is being discussed and say more.
Silence
● Verbalizing what is observed in the patient for validation and to encourage discussion.
● “You sound angry.
Stating and Observing
● Asking to describe similarities and differences among feelings, behaviors and events.
● “Can you tell me what makes you more comfortable, working by yourself or working as a member of a team?”
Encouraging Comparison
● Asking to identify recurring thoughts, feelings and behaviors.
● “When do you always feel the need to check the locks and doors?”.
Identifying themes
● Reviewing the main points of discussion and making appropriate conclusions.
● “During this meeting, we discussed about what you will do when you feel the urge to hurt yourself again and this include…”
Summarizing
● Asking for relationships among events.
● “When do you begin to experience this tick? Before or after you entered grade school?”.
Placing the event in time and sequence
● Voicing uncertainty about the reality of patient’s statements, perceptions and
conclusions.
● “I find it hard to believe…”
Voicing doubt
● Asking the patients to describe feelings, perceptions and views of their situations.
● “What are these voices telling you to do.”
Encouraging descriptions of perceptions
● Stating what is real and what is not without arguing with the patient.
● “I know you hear these voices, but I do not hear them”.
● “I am Deborah, your nurse, and this is a hospital and not a beach resort”.
Presenting reality or confronting
● Asking the patients to restate, elaborate, or give examples of ideas or feelings to seek clarification of what is unclear.
● “I am not familiar with your work; can you describe it further for me”.
● “I don’t think, I understand what you are saying”.
Seeking clarification
● Rephrasing patient’s words to highlight an underlying message to clarify
statements.
● Patient: I will not be bothering you anymore soon.
● Nurse: Do you think you should leave now?
Verbalizing the implied
● Throwing back the patient’s statements in a form of questions helps the patient
identify feelings.
● Patient: I think I should leave you now
● Nurse: Do you think you should leave now?
Reflecting
● Repeating the exact words of patients to remind them of what they said and to let them know they are heard.
● Patient: I cannot sleep. I stay awake all night.
● Nurse: You cannot sleep at night?
Restating
● Using neutral expressions to encourage patients to continue talking.
● “Go on…”
● “You were saying…”
General leads
● using open-ended questions to achieve relevance and depth in discussion.
● “How did you feel when the doctor told you that you are ready for discharge soon?”
Asking question
● Recognizing and acknowledging patient’s feelings
● “It’s hard to begin to live alone when you have been married for more than thirty years”.
Empathy
● Pursuing a topic until its meaning or importance is clear.
● “Let us talk more about your best friend in college.”
● “You were saying…”
Focusing
● Providing a view of the meaning or importance of something.
● Patient: I always take this towel wherever I go.
● Nurse: That towel must always be with you.
Interpreting
● Asking for patients views of the meaning or importance of something.
● “What do you think led to court to commit you here?”.
● “Can you tell me the reasons you don’t want to be discharged?”.
Encouraging Evaluation
● Offering to help patient solve problems.
● “Perhaps you can discuss this with your children so they will know how you feel and what you want”.
Suggesting Collaboration
● Asking patient to decide on the type of change needed.
● “What do you think about the things you have to change in yourself?”.
Encouraging goal setting
● Probing for step-by-step actions that will be needed.
● “If you decide to leave home when your husband beat you again and what will you do
next?”.
Encouraging formulation of a plan of action
● Asking patients to make a choice among options.
● “Given all these choices, what would you prefer to do?”.
Encouraging decisions
● Asking patients to consider the pros and cons of possible options.
● “Have you thought of the possible effect of your decision to you and your family?”.
Encouraging consideration of options
● Providing information that will help patients to make better choices.
● “Nobody deserves to be beaten and there are people who can help and places to go when you do not feel safe at home anymore”.
Giving Information
● Discouraging nonproductive feelings and behaviors and encouraging productive ones.
● “Please stop now. If you don’t, I will ask you to leave the group and go to your room.”
Limit Setting
● Acknowledging the difficulty in changing but pushing for action.
● “I understand you feel rejected when your children sent you here but if you look at
this way…”
Supportive confrontation
● Practicing behaviors for specific situations, both the nurse and patient play a particular role.
● “I’ll play your mother, tell me exactly what you would say when we meet on Sunday”.
Role Playing
● Asking the patient for a verbal description of what will be said or done in a particular situation.
● “Supposing you meet these people again, how would you respond to them when they ask you to join them for a drink?”.
Rehearsing
● Pointing out specific behaviors and giving impressions of reactions.
● “I see you combed your hair today”/
Feedback
● Asking patients to evaluate their actions and their outcomes.
● “What did you feel after participating in the group therapy?”.
Encouraging evaluation
● Giving feedback on positive behaviors.
● “Everyone was able to give their options when we talked one by one and each of them
waited patiently for our turn to speak.”
Reinforcement
AVOID PITFALLS:
- Giving advice
- Talking about yourself
- Telling client is wrong.
- Entering hallucinations and delusions of client
- False reassurance
- Cliché
- Giving approval
- Asking WHY?
- Changing subject
- Defending doctors and other health team members
NON-THERAPEUTIC TECHNIQUES:
- Overloading
- Value Judgements
- Incongruence
- Underloading
- False reassurance agreement
- Invalidation
- Focusing on self
- Changing the subject
- Giving advice
- Internal validation
● Talking rapidly, changing subjects too often, and asking for more information than can be absorbed at one time.
● “What’s your name? I see you like sports. Where do you live?”.
Overloading
● Giving one’s own opinion, evaluating, moralizing, or implying one’s values by using words such as “nice”, “bad”, “right”, “wrong”, “should”, and “ought”.
● “You shouldn’t do that, it’s wrong.
Value Judgements
● Sending verbal and non-verbal messages that contradict one another.
● The nurse tells the patient “I’d like to spend time with you’ and then walks away.
Incongruence
● Remaining silent and unresponsive, not picking up cues, and falling to give feedback.
● The patient asks the nurse, but the nurse simply walks away.
Underloading
● Using cliché to reassure client.
● “It’s going to be alright”.
False reassurance agreement
● Ignoring or denying another’s presence, thoughts or feelings.
● Client: How are you?
● Nurse responds I cannot talk now. I am too busy.
Invalidation
● Responding in a way that focuses attention to the nurse instead of the client.
● “This sunshine is good for my roses. I have a beautiful rose garden.”
Focusing on self
● Introducing new topic.
● Inappropriately, a pattern that may indicate anxiety.
● The client is crying when the nurse asks. “How many children do you have?’.
Changing the subject
● Telling the client what to do, giving opinions or making decisions for the client, implies client cannot handle his or her own life decisions and that the nurse is accepting responsibility.
● “If I were you. Or it would be better if you do it this way.
Giving advice
● Making an assumption about the meaning of someone else’s behavior that is not
validated by the other person (jumping conclusions).
● The nurse sees a suicidal client smiling and tells another nurse the patient is in good mood.
Internal validation
– your doctor is very good.
● Defending
– Why did you do that?
● Requesting an explanation
– if you feel empty then you should eat more.
● Literal responses
– You are not supposed to talk like that!
● Reflecting
– “Everything will be alright”, “Don’t worry”.
● False reassurance/reassuring
– “That’s good”.
● Giving approval
– “I don’t want to hear about”.
● Rejecting
– “That’s bad, “I rather you wouldn’t’.
● Disapproving
– “I don’t believe that”.
● Disagreeing
– “Why don’t you”.
● Advising
– “That’s right”.
● Agreeing
– asking questions for curiosity only. “Now tell me about”, “Why did you”.
● Probing
– ‘If you’re dead why is your heart beating”.
● Challenging
– “I felt that way too”. When patient says she feels everything is against her.
● Belittling
– “What day is it”. “Do you know the kind of hospital this is”.
● Testing
– “of course your something”.
● Using denial
– “It’s for your own good. “Nice weather we are having’.
● Making stereotype comments
– “What you really mean is”.
● Interpreting
– ‘If you don’t eat, will be forced to tube feed you.
● Threatening
– crossing arms on chest
● Having a closed posture
– I’ll make sure to call you when you get home.
● Making false promises
– I can’t talk to you right now.
● Ignoring the client
-You should not do those things.
● Showing disapproval
● Refers to the experience or series of experiences between the nurse and the patient.
● Refers to the total relationship.
● Mutually defined relationship.
● Provides counselling, crisis intervention and individual therapy.
NURSE- PATIENT RELATIONSHIP
● Any nurse patient contact during which the nurse and the patient have reciprocal influence on each other, communicating verbally and non-verbally.
● Refers to communication.
NURSE – PATIENT INTERACTION
CHARACTERISTIC OF NURSE-PATIENT RELATIONSHIP:
- Listening
- Warmth
- Genuineness
- Attentiveness
- Empathy
- Positive regard
– perceiving the patient’s message in the cognitive level and affective domain.
- Listening
– being oneself and non-acting out a role; being open & truthful.
- Genuineness
– feeling of cordiality and inaction.
- Warmth
– understanding the patients feeling & viewing the world as he/she does.
- Empathy
– demonstrating a concentration of time & attention to the patient.
- Attentiveness
– accepting the patient as he/she is.
- Positive regard
INTERVIEWING TECHNIQUES:
● REFLECTION.
● RESTATING.
● FACILITATION.
● OPEN-ENDED QUESTIONS.
● CLOSE-ENDED QUESTIONS.
● SILENCE.
● BROAD OPENING.
● CLARIFICATION.
repeating content or feelings. “It sounds like you’re concerned about your family”. OR “I don’t think you’re very happy about this.”
● REFLECTION.
rephrasing a question or summarizing a statement. “You’re asking why these tests are needed? OR “In other words you think you’re being treated like a child”.
● RESTATING.
Questions that encourage the patient to expound a topic. If you want to encourage the patient to speak freely, you might ask “How are you feeling” rather than “Are you in pain?”.
● OPEN- ENDED QUESTIONS.
occasional brief responses, which encourage the speaker to continue. A nod of the head; an occasional verbal cue, such as “go on” or “I see” and maintaining eye contact throughout the conversation all imply that you are listening and that you understand.
● FACILITATION.
Questions, which focus the patient on a specific topic. If you want a short, straight answer, ask a question which will allow only for a direct response such as “When was your accident?” or “Do you have pain after eating?”.
● CLOSE-ENDED QUESTIONS.
A quiet period that allows a patient to gather his thoughts. Of course, this would be an occasional practice, used when you feel that the patient could use a little time to think about his response to a question or just to think.
● SILENCE.
A few words to encourage the patient to further discuss a topic. For
example,” and after that…” or “you were saying….”
● BROAD OPENING.
● It is a tool that the nurse can use to assess each patient’s problems, select and carry out
specific interventions, and evaluate the effectiveness of care.
PHASES OF NURSE- PATIENT RELATIONSHIP
Statements or questions that verify a patient’s concern or point. “I’m a bit confused about….” “Do you think you could go over that again please?”.
● CLARIFICATION.
PHASES OF NURSE- PATIENT RELATIONSHIP:
A. ORIENTATION/INITIATION PHASE
B. WORKING PHASE
C. TERMINATION PHASE
● Establish boundaries.
● Inform about time, place, duration of each meeting & the length of the relationship will be in effect (WHEN, HOW LONG, HOW OFTEN THE NURSE WILL MEET THE CLIENT).
● Build trust & rapport (acceptance).
A. ORIENTATION/INITIATION PHASE
● Explore patient’s perception of reality.
B. WORKING PHASE
● End of relationship, discuss of termination.
C. TERMINATION PHASE
- is a written account recording of all that transpired, during and immediately following the nurse patient interaction. It is a recording of the conversation during the interaction or the interview between the nurse and the patient in the psychiatric set-up with the nurse inference.
Process Recording
