Therapeutic Communication Flashcards
Agreeing with and opposing the client’s ideas implies that the nurse has the right to judge, agreeing prevents the client from changing his/her view, disagreeing provokes defensiveness.
Ex. “That’s right. I agree”
“That’s bad. I disagree”
Agree/disagreeing (non-therapeutic)
Implies criticism, often puts the patient on the defensive.
Ex. “Why did you stop taking your medications?”
Asking “Why” questions (Non-therapeutic)
Minimizing problems and discomfort conveys a lack of empathy and understanding. Saying “perk up” and “snap out of it” causes the client to feel insignificant and unimportant.
Ex. Client: “I have nothing to live for. I wish I were dead”
Nurse: “Everybody gets down in the dumps. I feel that way sometimes”
Better: “You must be very upset. Tell me what you are feeling right now”
Belittling (non-therapeutic)
Demanding proof from client tends to strengthen and expand his/her misinterpretation of reality.
Ex. “How can you possibly be Jesus?”
“Show me your million dollars.”
Challenging (NT)
Introducing an unrelated topic blocks communication.
Ex. Client: “I want to die.”
Nurse; “Did you have visitors today?”
Changing the subject (NT)
Attempting to protect someone or something from verbal attack. Implies that the client does not have a right to express ideas, opinions, or feelings.
Ex. Client: “My daughter is hateful to me”
Nurse: “She must be awful to live with”
Criticism of others (NT)
Results in pt no knowing what questions to answer.
Ex. How’s your appetite? Are you losing weight? Are you eating enough?
Excessive questioning (NT)
Attributing the source of thoughts, feeling, and behavior to outside influences encourages the client to project blame for his/her thoughts and behaviors upon others rather than accepting the responsibility personally.
Ex. “What makes you say that?”
:What made you do that?”
“What made you so angry?”
Better to say: “You became angry when your brother insulted your wife?”
Indicating the existence of an external source of power (NT)
Rushes the client and disregards input. Nurse misses what the client is trying to convey.
EX. “I think this is what you really mean. “
Interpreting or analyzing prematurely (NT)
Demonstrates a lack of acceptance of the client’s differences and provides a barrier to further disclosures.
Ex. “You are thinking about divorce when you have 3 children?”
Making value judgments (NT)
Cuts off communication. The nurse is trying to make the patient feel better, but is not addressing the problem.
Ex. Everyone feels that way at times; it’s not a big deal. “
Minimizing the problem. (NT)
Shows the patient that the nurse is not interested, is too busy to talk or is preoccupied with personal issues.
Ex. “I’m sorry, what did I say?”
“Could you start again, I was listening to another client”
Not Listening (NT)
Discourages independent thinking.
Ex. “I think you should”
Offering advice (NT)
Devalues the client’s feelings, shows lack of understanding, and discourages the expressions of feelings.
Ex “Don’t worry about anything. Everything is going to work out.”
Offering false reassurance (NT)
Making stereotyped comments, cliches’ and trite expressions are meaningless and encourage superficial responses from clients.
Ex. “It’s for your own good. Keep your chin up!”
Offering superficial comments (NT)
Pushing for answers to issues the client does not wish to discuss, causes the client to feel used, places client on defensive. Ex. "What did you tell your wife?" "What did you discuss in therapy?" "Why do you do this?" "Why do you feel this way?"
Probing (NT)
Not allowing the client to express thoughts and feelings, blocks communication.
Ex “I don’t want to hear about that again”
Rejecting NT
Encourages the client to invent reasons, give partial answers and expand delusional system. Intimidating and causes defensiveness.
Client:”I’m so nervous.”
Nurse:”Why are you so nervous?”
Better to say: “Describe what happened just before you started feeling nervous.”
Requesting an explanation (NT)
Focus is taken away from the client, who is seeking help.
Ex. “That may have happened to you last year, but I’ve been through that twice already this month…”
Self-focusing (NT)
Refusing to admit a problem exists closes off an avenue of discussion and avoids helping the client from exploring areas of difficulty.
Ex. Client:I”m nothing
Nurse: “Everybody is something”
Better to say: Your feeling like no one care about you right now.”
Using denial
Responding to a figurative comment as a statement of fact.
Client: I am dead.
Nurse: Then why is your heart still beating?
Better to say: Are you saying you feel lifeless?
Giving literal responses NT
Verbal and nonverbal skills that conveys to the patient that the nurse is paying attention. Conveys regard and interest.
Ex. “In an open position, eye contact, “Go, on, I am listening. “
Nurse “Yes” Eye contact, nodding.
Active Listening/Accepting (TC)
Asking clients to decide on the type of change needed.
Nurse: “What do yo think needs to change?”
“What do you want to do differently?”
Assisting in goal setting (TC)
Responds to the feeling expressed, not just the content.
EX. Client; “I am dead inside”
Nurse: “Are you saying you feel lifeless?”
Attempting to translate into feelings (TC)
Recognizing and acknowledging the client’s feelings without losing objectivity.
Ex. Nurse: “I can hear how much this has hurt you.
Empathizing TC
Asking for similarities and differences among feelings, behaviors, and events.
ex. Nurse”How does this compare to the last time?” “What is different about your feelings today?”
Encouraging comparison (TC)
Asking the clients to make a choice among options.
Nurse:”What would work best for you?”
Encouraging decisions (TC)
Asking for client’s view of the importance of something.
Nurse:” What does all this mean to you? How serious is this for you? How important is it to change this behavior?
Encouraging evaluation TC
Asking for clients view of his/her situation, often used with clients experiencing hallucinations.
ex. Nurse; “Can you tell me what is happening now?”
Encouraging descriptions of perceptions TC
Asking for step-by-step actions that will be needed.
Nurse: “What exactly will it take to carry out your plan? what else do you need to do?
Encouraging plan formulation. TC
Helps the client see that new thoughts and actions can be accomplished after discharge
ex. Nurse: “How can a relapse prevention plan assist you after you leave the hospital? “
Encouraging post hospital transition TC
Asking client to evaluate his/her actions and outcomes. Determining progress. Encourages clients to look at their behavior and the outcomes it produces.
Nurse:”How well did it work when you tried ____?”
Client:” I am getting better.”
Nurse: “In what ways do you feel better? How well did it work when you tried…..?
Evaluating actions TC
Obtaining all pertinent data on a particular subject or feeling to move beyond superficial.
Client; “I don’t feel well today. “
Nurse: ‘ What seems to be the matter? “
Exploring
Pursuing a topic until its meaning or importance is clear.
Client; “Women always get put down. It’s as if we don’t count at all.”
Nurse: “Tell me how you feel as a woman”
Focusing TC
Allows the client to introduce a topic.
Nurse” What would you like to talk about?”
Giving broad openings TC
Indicates awareness.
Nurse: Good morning Mr. J. I noticed that you’ve combed your hair.”
Giving recognition TC
Asking clients to identify recurrent patterns in thoughts, feelings, and behaviors.
Nurse: What do you do each time you argue with your wife? What feeling do yo get when you see your father?”
Identifying themes
Verbalizing what is observed.
Nurse” I notice you are pacing a lot”
Making observations. TC
Asking clients to consider the pros and cons of possible solutions.
Nurse: What would be the advantage of trying_____? What might happen if you tried ____?”
Offering alternatives TC
Encourages client to continue.
Nurse: Go on. Tell me more”
Offering general leads TC
Making self available. showing interest in client.
Nurse: I’d like to spend more time with you. “
Offering self TC
Clarifies the relationship of events in time.
Nurse: What seemed to lead up to ____?
Placing the event in time and order TC
Offering a view of what is real and what is not without arguing with the client.
Nurse: “I know the voices are real to you, but I don’t hear them. I see no one else in the room but you and me.”
Presenting reality TC
Pointing out specific behaviors and giving impressions of reactions.
Ex Nurse: “I thought you conveyed anger when you said ____. When you said ___I felt ____. “
Providing feedback. TC
Providing information that will help clients make better choices.
Nurse” I can tell you about your medications”.
Providing information TC
Using open-ended questions to achieve relevance and depth in discussion.
Nurse: “Who? What? When? Where What happened? Tell me about it” Do Not Use WHY
Questioning TC
Directs back the clients feeling and ideas, validates the nurses understanding of what the client is saying, and conveys interest.
Client: My sister won’t help a bit with our mother’s care. I have to do it all!”
Nurse: You feel angry when she doesn’t help?’
Reflecting TC
Giving feedback on positive behaviors.
Nurse” This new approach worked for you. Keep it up.
Reinforcing healthy behaviors TC
Repeating main idea lets client know he/she was heard and encourages client to continue.
Client: I can’t take that new job. What if I can’t do it?
Nurse: You’re worried that you might fail in this new job?
Restating
Practicing behaviors with the nurse playing a particular role. Requesting a verbal description of what will be said or done.
Nurse: I’ll play your son. What do you want to say to me?
Nurse: Tell me what you will say to your son on Friday.
Role playing TC
Discouraging nonproductive feelings and behaviors and encouraging productive ones.
Nurse: I feel uncomfortable when you put your arm around me. Therefore, I will leave next time.
Setting limits
Asking clients to state, elaborate and give examples.
Client; “I have a pass to go home for the weekend”
Nurse: What does this mean to you?
Seeking Clarification TC
Confirming one’s observations
Nurse: Let me know if this is how you see it.
Seeking Consensual Validation TC
Offering to help clients solve problems.
Nurse: Let’s see if we can work together to find an answer.
Suggesting collaboration/alternatives
Recalling important points, bringing discussion to a conclusion.
Nurse” During the last half hour we discussed ___.
Summarizing TC
Acknowledging the difficulty in changing, but pushing for action.
Nurse: You are slipping into your aggressive tone again. Try an assertive tone instead.
Supportive confrontation TC
Encourages client to initiate conversation, allows client time to think
Nurse: Sit with client and non-verbally communicate interest and involvement.
Using silence TC
Rephrasing the client’s words to highlight an underlying message.
Client “There is nothing to do at home”
Nurse: It sounds like you might be bored at home”
Verbalizing the implied TC
Expressing uncertainty about the reality of client’s perceptions and conclusions
Nurse: Is that the only way to interpret it?
What other conclusion could there be?
Voicing doubt TC
as “the successful adaptation to stressors from the internal or external environment, evidenced by thoughts, feelings, and behaviors that are age-appropriate and congruent with local and cultural norms”-Townsend
Mental health
“a state of being that is relative rather than absolute. The successful performance of mental functions shown by productive activities, fulfilling relationships with other people, and the ability to adapt to change and to cope with adversity” -Black and Andreasen
Mental health
Two elements assoc with individuals perception of mental illness
- incomprehensibility
- cultural relativity
relates to the inability of the general population to understand the motivation behind the behavior.
incomprehensibility
The element of cultural relativity considers that these rules, conventions, and understandings are conceived with an individual’s own particular culture.
Cultural relativity
“a health condition characterized by significant dysfunction in an individuals cognition, emotions or behaviors that reflects a disturbance in the psychological, biological or developmental processes underlying mental functioning”
APA’s definition of Mental Disorder
the process by which nurses provide care for clients in need of psychosocial intervention. “tools of psychosocial interaction”
Therapeutic interpersonal relationship
primary task in relationship building;
can be established by talking about non-health related topics
rapport
unconditional positive regard. attitude is nonjudgemental and the respect is unconditional in that it doesn’t depend on the behavior of the client to meet certain standards.
respect
earned, warmth and caring. Confidentiality
trust
open & honest “real”
genuniness
accurately perceives or understands what the client is feeling and encourages the client to explore these feelings. Not to be confused with sympathy.
This means you remain emotionally seperate.
Empathy
“shares” what the client is feeling and experiences. Do not do this!
Sypathy
- Pre-interaction: explore self-perceptions
- Orientation: (introductory): Establishes trust and formulates contract for intervention
- Working: Promote client change
- Termination: Evaluate goal attainment and ensure therapeutic closure.
Phases of Relationship Development and Major Nursing Goals.
occurs when the client unconsciously displaces (or transfers) to the nurse feelings formed toward a person from his/her past.
Transference
refers to the nurse’s behavioral and emotional response to the client.
Countertransference
Sit squarely facing client Observe an open posture. Lean forward toward client. Establish eye contact. Relax
SOLER-Nonverbal behaviors for active listening
What happens in the orientation phase of the therapeutic relationship?
Introductory; establish trust and formulate contract for intervention
What happens in the working phase of TC?
Promote client change
what happens in the termination phase of TC?
Evaluate goal attainment and ensure therapeutic closure
What is transference?
occurs when the client unconsciously displaces or transfers to the nurse feeling formed towards a person from his/her past.
What is countertransference?
refers to the nurses behavior and emotional response to the client.
Discuss strategies for communication with a manipulative client.
Put the focus on them; ask questions. ie..Are you asking me or telling me? Does this seem reasonable to you?
Say that you will have to think about it.
Discuss strategies for communication with a client who is hallucinating.
Use distractions. Suggest going for a walk or another room that is well lit where other people are present. Draw attention to music, conversation or activities. Check for disrupting sounds (tv, AC, etc.) Cover mirrors.
Discuss strategies for communication with a client who is uncooperative.
Reduce negative thoughts before conversation even starts. Avoid judgements, step back and don’t say anything. Remain open to what they need to say.
What is the term used to describe word choice, tone, pitch and rate of speech?
Verbal Communication
What is the term used to describe body movement, facial expressions and posture?
Non-verbal communication; body language
How does culture influence communication?
through different life experiences based on cultural norms-can affect interpretation of messages delivered by others.
