Therapeutic Communication Flashcards
Phases of a therapeutic nurse-patient relationship
– preinteraction
– orientation
– working
– termination
Preinteraction
– Before first contact
– Self-understanding
– Self-assessment
Introductory or Orientation Phase
– Includes pt’s reason for seeking help
Orientation Phase
- Formulating a response
- Exploring feelings
Formulating a contract
*Establish trust, understanding, acceptance, open communication, & contract
*Nurse-Pt contract
» Names
» Roles
» Responsibilities
» Expectations
» Purpose
» Meeting place and time
» Conditions for termina
Exploring feelings:
Includes exploring perceptions, thoughts, feelings, & actions
Working Phase
- Most of therapeutic work is carried out during this phase
- Explore stressors
- Promote the development of insight
- Master anxieties
- Increase independence & self-responsibility
- Develop constructive coping mechanisms
- Focus is on behavioral change
Termination Phase
- May be most difficult & most important
- Learning is maximized for both patient & nurse
- Exchange feelings & memories & evaluate pt. progress & goal attainment
- Consider: what are the criteria for determining readiness for termination
- Patient behavior may regress
Nonverbal Communication
- Physical Appearance
- Body Movement & Posture
- Touch
- Facial expression
- Eye behavior
- Vocal cues or paralanguage
Facilitative Communication
- Communication that facilitates the development of a therapeutic nurse-patient relationship
- Communication is verbal & nonverbal
- Meaning: 7% by words, 38% by paralinguistic cues (voice), & 55% by body cues.
OR
- 70 to 90% of all communication is nonverbal
Touch
– Use with great care
– Easily misinterpreted as invasion or sexual overture
– Can illicit an aggressive response
– Think about the flight or fight response of anxiety
3 elements of communication
- Perception: receiver
- Evaluation: receiver
- Transmission: response to sender from receiver, aka - feedback
Why Therapeutic Communication Techniques?
- Preserves self-respect
- Understanding precedes giving information or advice
- Common courtesy
- Make request and wait for response
Therapeutic communication technique examples
- Listening
- Broad openings
- Restating
- Clarification & validation
- Reflection
- General leads Placing the event in time or sequence
- Sharing perceptions
- Theme identification
- Silence
- Making observations
- Encouraging description of perceptions Encouraging comparison
- Focusing
- Accepting
- Recognizing
- Offering self
- Exploring
- Presenting reality
- Voicing doubt
- Verbalizing the implied attempting to translate words into feelings formulating a plan of action
Non-Therapeutic Communication
- Belittling feelings
- Judging
- Requesting an explanation
- Giving Advice
- Changing topics
- Probing
- Rejecting
- Defending
- Indicating an external source of power
- Giving Reassurance
Responsive Dimensions
- Genuiness
- Respect
- Empathy (how does this differ from sympathy?)
- Concreteness (how might this vary during different stages of the therapeutic relationship)
Action Dimensions
- Confrontation
- Immediacy
- Nurse self-disclosure
- Emotional catharsis
- Role playing
Confrontation
- Discrepancy between self-concept & self-ideal
- Discrepancy between verbal & nonverbal
- Discrepancy between pts expressed experience of self and the nurses experience of the pt.
- Effective confrontation is associated with empathy
Immediacy
- Focus on pts function in nurse-pt relationship
- Requires sensitivity to feelings & willingness/ability to deal with feelings
Nurse self-disclosure
– Use judiciously
– Always for pts benefit
Emotional catharsis
– Cues from pt indicate readiness
Therapeutic Impasses
- Resistance Transference Countertransference
- Boundary violations
– Role – Time – Place & space – Self-disclosure
Peplau (1991) identified several subroles within the role of the nurse, which are?
- Stranger
- The Resource Person
- The Teacher
- The Leader
- The Surrogate
- The Technical Expert
- The Counselor
The Stranger Subrole
The nurse is at first a stranger to the client. The client is also a stranger to the nurse.
Priniciples: (1) accepting the patient as he is; (2) treating the patient as an emotionally able stranger and relat- ing to him on this basis until evidence shows him to be otherwise.
