Therapeutic Communication-Ch 6-T1 Flashcards
Communication
Process to exchange of information
Messages are simultaneously sent & received on two levels
Verbal
Nonverbal
Verbal communication
use of words.
Content: literal words spoken.
Context: Situation that clarifies the meaning of the content; environment, circumstances, situation in which communication occurs.
Nonverbal communication
Behavior that accompanies the verbal content; body language, eye contact, facial expression, tone of voice, speed, moans.
May indicate speakers thoughts, feelings, & values unconsciously.
Process: denotes all messages used to give meaning & context to message; listener interprets for agreement with verbal content.
Congruent or incongruent message.
Therapeutic Communication
Interpersonal interaction between nurse & client - focuses on the client’s specific needs in order to promote an effective exchange of information
Communication is the means by which the therapeutic relationship is (3)
initiated, maintained, & terminated.
Goals of Therapeutic Communication
Establish a therapeutic relationship.
Identify client’s most important concerns; assess client’s perceptions.
Facilitate client’s expression of emotions.
Teach client, family necessary self-care skills.
Recognize client’s needs; implement interventions to address client’s needs.
Guide client toward more positive coping strategies & solutions
Distance zones (Proxemics)
Intimate (0 to 18 inches) – parents with young children.
Personal (18 to 36 inches) – family & friends.
Social (4 to 12 feet) – social, business setting.
Public (12 to 25 feet) – speaker & audience.
INTIMATE: distance zone
(0 to 18 inches) – parents with young children.
PERSONAL: distance zone
18 to 36 inches) – family & friends.
Therapeutic communication: most comfortable when nurse and patient are at what distance?
3-6 feet
Hispanic, Middle Eastern, Asian are more comfortable with ______ distance.
4 to 12 feet
What should you do before invading intimate or personal zone?
ask permission
Five types of touch:
functional/professional – i.e. exams/procedures
social–polite - i.e. handshake
friendship–warmth –i.e. hug
love–intimacy – i.e. kisses
sexual–arousal –i.e. used by lovers
when to use touch..
Evaluate client for cues that show whether touch is indicated.
The nurse must evaluate use of touch based on the client’s preferences, history, and needs.
For example, clients with a history of abuse, hospital/unit policies.
Active listening (d)
concentrating exclusively on what patient says
Active observation (d)
watching nonverbal actions as speaker communicates
active listening and active observation help the nurse to:
Recognize the most important issue.
Know what questions to ask.
Use of therapeutic communication techniques.
Prevents jumping to conclusions.
Objectively respond to message.
Verbal communication skills need concrete (d)______, clear and accurate information exchange
not abstract
Therapeutic Communication Techniques (see Table 6.1, pp. 102-104):
Exploring, focusing, restating, reflecting promotes discussion of feelings or concerns in more depth.
Other techniques useful in focusing or clarifying what is being said.
Feedback via making an observation or presenting reality.
Avoidance of nontherapeutic techniques (see Table 6.2, pp. 105-106):
Advising, belittling, challenging, probing, reassuring.
Interpretation of signals or cues
To understand what a client means, the nurse watches & listens closely for cues – verbal or nonverbal messages that signal key words or issues for the client.
Overt – clear, direct statements of intent (i.e. “I want to die”).
Covert – vague, indirect messages that need interpretation & exploration (i.e. “Nothing can help me”).
Word patterns need further clarification for meaning (themes, metaphors, proverbs, & clichés).
Overt (d) : verbal communication
clear, direct statements of intent (i.e. “I want to die”).
Covert (d):verbal communication
vague, indirect messages that need interpretation & exploration (i.e. “Nothing can help me”).
Word patterns need further clarification for meaning
themes, metaphors, proverbs, & clichés).
unconditional positive regard
Rogers
Nonverbal Communication Skills
facial expression
body language
vocal cues
eye contact
silence
Nonverbal Communication Skills:
Facial expression
connects words to illustrate meaning.
Expressive – portrays person’s moment by moment thoughts, feelings, needs.
Impassive – frozen into an emotionless expression similar to a mask.
Confusing – one opposite of what the person wants to convey.
Nonverbal Communication Skills:Body language
gestures, postures, movements, body positions.
NONVERBAL COMMUNICATION:
open body positions
vs
closed body positions
Open body position – sit facing client, legs uncrossed, hands at side.
Demonstrates unconditional positive regard, trust, care, & acceptance.
Nonthreatening eye contact, leaning forward indicates acceptance.
Closed body position –crossed legs, folded arms, might threaten listener.
Sitting behind desk creates barrier & decrease client’s willingness to open up.
Open body position (d)
What do they demonstrate?
sit facing client, legs uncrossed, hands at side.
Demonstrates unconditional positive regard, trust, care, & acceptance.
Nonthreatening eye contact, leaning forward indicates acceptance
closed body position (d)
crossed legs, folded arms, might threaten listener.
Sitting behind desk creates …
barrier & decrease client’s willingness to open up.
Vocal cues (d)
– nonverbal sound signals transmitted alongwith content (i.e. voice volume, tone, pitch, intensity, pauses that augment sender’s message).
Eye contact (d)
used to assess the other person, environment (increases during listening, decreases during speaking).
Silence(d) as nonverbal communication
long pauses in communication (may indicate person is thoughtfully considering question before responding).
Meaning (d)
usually more meaning than just spoken word
Context (d)
Need to accurately identify the meaning of the message
i.e. “I am going to kill you!” takes on two different messages depending on the context
Validation with client of verbal, nonverbal information
Assessment of the context focuses on (5)
- Who was there.
- What happened.
- When it occurred.
- How event progressed.
- Why client believes it happened as it did.
Spirituality
a client’s belief about life, health, illness, death, & one’s relationship to universe
How does spirituality differ from religion?
religion -is an organized system of beliefs.
spirituality - is a client’s belief about life, health, illness, death & ones relationship to the universe
Culture (d)
is all the socially learned behaviors, values, beliefs, & customs passed down to each generation
Each culture has rules governing verbal & nonverbal communication.
The nurse needs to be aware of the cultural differences relating to the following things:
Speech patterns, habits Styles of speech, expression Eye contact Touch Concept of time Health, health care
THERAPEUTIC COMMUNICATION SESSION:
The nurse uses therapeutic communication skills to achieve the following goals:
Establish rapport by being empathetic, genuine, caring, unconditionally accepting of the person.
Identify issues of concern.
Gain an in-depth understanding of the client’s perception.
Explore client’s thoughts, feelings.
Guide client in developing problem-solving skills.
Promote client’s evaluation of solutions.
THERAPEUTIC COMMUNICATION SESSION: process
initiate session with an -
- introduction
- Establishment of contract for relationship.
- Identification of major concerns
THERAPEUTIC COMMUNICATION SESSION: the nurse takes on a nondirective role or a directive role. explain each
Nondirective role (nurse uses broad-opening, open-ended questions to collect information).
Client identifies problem to discuss & goal.
Nurse acts as guide & facilitates expression of feelings.
Directive role (direct yes/no questions; usually for clients with suicidal thoughts, in crisis, or who are out of touch with reality).
How to Phrase Questions:
clarification (d)
to confirm nurse’s understanding of what client is conveying.
How to Phrase Questions:
Identification (d)
of client’s avoidance of anxiety-producing topic.
Client may begin discussing topic of minimal importance because it is less threatening than issue that is increasing anxiety.
Ask client which issue is most important at this time.
How to phrase questions:
guidance in problem-solving, empowerment to change
Involve client as he/she is more likely to follow through on the solutions.
Assertive Communication
Expression of positive and negative feelings/ideas in open, honest, direct way.
Calm, specific factual statements.
Focus on “I” statements.
types of communication aggressive (d) passive-agressive(d) Passive (d) Assertive (d)
Aggressive – “You are always late!”
Passive–aggressive – “So nice of her to join us – aren’t we lucky.”
Passive – makes statement to others but not to the specific nurse who is late.
Assertive –” When you are late, shift report is disrupted, and I do not like having to repeat information that was already discussed.”)
community based care
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Nurses increasingly caring for high-risk patients in homes; families becoming more responsible for primary prevention.
Therapeutic communication techniques & skills are essential for caring for patients in the community.
Increased self-awareness, knowledge needed about cultural differences; sensitivity to beliefs, behaviors, feelings of others.
Collaboration with patient & family as well as other health-care providers.
Self-Awareness Issues
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Nonverbal communication: as important as verbal.
Therapeutic communication influential in effectiveness of interventions.
Awareness of own communication is first step in improving communication.
Ask for feedback from colleagues.
Examine own communication skills.
Ongoing process of evaluating how our own emotional responses to clients affect both verbal & nonverbal communication
