Therapeutic Communication

1. Therapeutic Communication The Helping Interview

2. Caring Hopeful Sensitive Genuine Empathy Positive Regard Values Self & Others Empowering Teaching Goal- Oriented, Purposeful Time Limited Assertive Helping Relationship Characteristics

3. HELPING Care Trust Growth Purposeful/Intentional Unequal Sharing Focus on Client’s Needs Time Limited SOCIAL Care Trust Growth Spontaneous Similar Sharing Focus on Needs of Both Individuals Ongoing Helping vs Social Relationships

4. GIVING HELP feeling important feeling useful feeling powerful feeling gratified feeling happy NEEDING HELP feeling unimportant or inadequate feeling useless or depressed feeling powerless feeling frightened or embarrassed feeling sad or angry Control

5. Phases of Helping Relationship • Orientation (professional and client to each other) • Working (identification of the client’s problem) • Termination (resolution of the client’s problem)

6. Orientation Phase • “getting to know you” phase • sets the tone • introductions • roles • initiated by the nurse • agreement/contract/goals • trust develops

7. TRUST • T try expression • R reflection • U use of silence • S setting limits • T time with client

8. Working Phase • “problem solving” phase • attend to client’s needs • role of teacher/counselor • client actively participates • gather further data • facilitate change • evaluate problems & goals

9. Termination • “ending” phase • review and summarize progress & goals met/not met • acknowledge feelings • use clear language • check the receiver understands the message sent

10. Resolution • clients mostly seeking explanation • how will problem affect their lives? • what will need to be changed? • how will they cope?

11. arguing minimizing challenging giving false reassurance interpreting or speculating on the dynamics of the client’s problems “selling” client on accepting treatment probing sensitive areas participating in criticism of any staff member joining any attacks led by client Avoid

12. Nursing Interventions to EncourageThe Helping Relationship • active listening • therapeutic communication techniques • other factors

13. attentive listening scale • hard to maintain eye contact • respond before other finishes speaking • finish other people’s sentences • talk on and on so no one can respond • go on working while someone is talking to you • repeat a point just made • allow your mind to wander during a conversation

14. good listening • STOP TALKING • put the speaker at ease • show that you want to listen • remove distractions • empathetic • be patient • hold your temper • go easy on argument and criticism • STOP TALKING

15. communication techniques • open ended questions (closed for obtaining specific information) • validating/clarifying • reflective/restating & paraphrasing • sequencing • sharing observations • acknowledging feelings

16. interpersonal skills • warmth and friendliness • openness (acceptance) • consideration of client variables • non-english speaking • developmental considerations • older adults • sociocultural • occupational • patients with special needs

17. other factors promoting therapeutic communication • comfortable environment • Providing some personal space • privacy • confidentiality • client focus • optimal pacing • nursing observations

18. failure to respect client failure to listen minimizing feelings inappropriate comments & questions excessive questions yes/no questions why & how probing changing the subject leading questions advice judgmental false reassurance giving approval/disapproval blocks to communication

19. THERAPEUTIC facilitates transformation of working nurse/patient relationship relationship allows for adequate & accurate assessment & data collection performed with patient, not for patient NON-THERAPEUTIC hinders relationship formation prevents patient from becoming mutual partner & relegates him/her to passive recipient of care therapeutic vs non-therapeutic

20. use self disclosure to help clients open up to you – not to meet your own needs keep your disclosures very brief don’t imply that your experience is exactly the same as the client’s only self-disclose about situations that you have mastered monitor your own comfort with self-disclosure respect your client’s needs for privacy remember that there are cultural variations in the amount of self-disclosure considered appropriate identify risks and benefits of self disclosure discuss the goals of the use of therapeutic self-disclosure disclosure, yes or no?

21. medical care is not enough! We need more than medical care or surgery--we need competent care & a good communicator