Chapter 6 Therapeutic Communication

1. Chapter 6Therapeutic Communication

2. Communication • Exchange of information • Verbal • Content: literal words spoken • Context: environment, circumstances, situation in which communication occurs • Nonverbal • Process: all messages used to give meaning, context to message • Congruent or incongruent message

3. Therapeutic Communication • Interpersonal interactions; focus on patient’s needs • Need for privacy • Encompasses goals that facilitate the nursing process

4. Therapeutic Communication (cont.) • Goals of therapeutic communication • Establish therapeutic relationship • Identify patient’s most important concerns; assess patient’s perceptions • Facilitate patient’s expression of emotions • Teach patient, family necessary self-care skills • Recognize patient’s needs; implement interventions to address patient’s needs • Guide patient toward acceptable solutions

5. Therapeutic Communication (cont.) • Touch • Five types: functional/professional; social–polite; friendship–warmth; love–intimacy; sexual–arousal • Comforting and supportive; also possible invasion of intimate and personal space

6. Question • Tell whether the following statement is true or false? • A distance of 2 feet between the nurse and patient is adequate for promoting comfortable therapeutic communication.

7. Answer • False • Rationale: For effective therapeutic communication, a distance of 3 to 6 feet between the nurse and patient would be most appropriate.

8. Verbal Communication Skills • Need for concrete, not abstract, messages • Techniques (see Table 6.1) • 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

9. Verbal Communication Skills (cont.) • Avoidance of nontherapeutic techniques (see Table 6.2) • Advising, belittling, challenging, probing, reassuring • Interpretation of signals or cues • Overt • Covert (themes, metaphors, proverbs, clichés)

10. Nonverbal Communication Skills • Facial expression • Expressive • Impassive • Confusing • Body language • Open body position • Closed body position

11. Nonverbal Communication Skills (cont.) • Vocal cues • Eye contact • Silence

12. Therapeutic Communication (cont.) • Respect for boundaries • Distance zones • Intimate (0 to 18 inches) • Personal (18 to 36 inches) • Social (4 to 12 feet) • Public (12 to 25 feet) • Therapeutic communication: most comfortable when nurse and patient are 3 to 6 feet apart

13. Therapeutic Communication (cont.) • Active listening (concentrating exclusively on what patient says) • Active observation (watching nonverbal actions as speaker communicates)

14. Understanding Meaning, Context, and Spirituality of Communication • Meaning: usually more meaning than just spoken word • Context • Validation with client of verbal, nonverbal information • Who, what, when, how, why

15. Understanding Meaning, Context, and Spirituality of Communication (cont.) • Spirituality • Self-awareness of own spiritual beliefs • Need for objectivity and nonjudgmental attitude about patient’s beliefs

16. Cultural Considerations • Need for awareness of cultural differences • Speech patterns, habits • Styles of speech, expression • Eye contact • Touch • Concept of time • Health, health care

17. Question • Which of the following would be a nontherapeutic communication technique? • A. Reassuring • B. Reflecting • C. Focusing • D. Exploring

18. Answer • A. Reassuring • Rationale: Reassuring is a nontherapeutic technique because it attempts to dispel the patient’s feelings. • Reflecting, focusing, and exploring are examples of therapeutic communication techniques.

19. Therapeutic Communication Session • Goals • Establishing rapport • Identifying issues of concern • Being empathetic, genuine, caring, unconditionally accepting of the person • Understanding patient’s perception • Exploring patient’s thoughts, feelings • Developing problem-solving skills • Promoting patient’s evaluation of solutions

20. Therapeutic Communication Session (cont.) • Initiation of session • Introduction • Establishment of contract for relationship • Identification of major concern • Nondirective role (broad-opening, open-ended questions) • Directive role (direct yes/no questions; usually for patients with suicidal thoughts, in crisis, or who are out of touch with reality)

21. Therapeutic Communication Session (cont.) • Proper phrasing of questions • Clarification • Identification of patient’s avoidance of anxiety-producing topic • Guidance in problem-solving, empowerment to change

22. Assertive Communication • Expression of positive and negative feelings/ideas in open, honest, direct way • Calm, specific factual statements • Focus on “I” statements • Possible responses • Aggressive • Passive–aggressive • Passive • Assertive

23. Community-Based Care • Nurses increasingly caring for high-risk patients in homes; families becoming more responsible for primary prevention • Therapeutic communication techniques and 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 and family as well as other health-care providers

24. Question • Tell whether the following statement is true or false? • Assertive communication focuses on identifying negative feelings.

25. Answer • False • Rationale: Assertive communication focuses on the expression of positive and negative feelings or ideas in an open, honest, direct manner.

26. Self-Awareness Issues • 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