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Therapeutic Communication

Therapeutic Communication. Prepared by Sally McDonald Revised by Tim Corbett. HELPING Care Trust Growth Purposeful/intentional Unequal sharing Focus on Client’s needs Time limited. SOCIAL Care Trust Growth Spontaneous Usually equal or near equal sharing Focus on needs of

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Therapeutic Communication

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  1. Therapeutic Communication Prepared by Sally McDonald Revised by Tim Corbett

  2. HELPING Care Trust Growth Purposeful/intentional Unequal sharing Focus on Client’s needs Time limited SOCIAL Care Trust Growth Spontaneous Usually equal or near equal sharing Focus on needs of both individuals Ongoing Helping vs Social Relationships

  3. 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 Locus of Control

  4. Phases of Helping Relationships • Orientation Phase • Working Phase • Termination Phase

  5. Orientation Phase • “getting to know you” phase • setting the tone • making introductions • establishing roles • reaching agreement on goals • developing trust

  6. Working Phase • “problem solving” phase • attending to client’s needs • Nurse in role of teacher/counselor • encouraging active participation by client • gathering further data • assisting client in decision making • facilitating change • Evaluate problems & goals

  7. Termination Phase • reviewing & summarizing goals met and progress made • acknowledge feelings of loss • reassuring clients with issues such as, “How will this problem/disease affect my life ?” or “What do I need to change ?”

  8. Active Listening • 3 Phases • restatement involves repeating or paraphrasing the words of the client • reflection is verbalizing both the content and the implied feelings of the client’s message • clarification is summarizing the client’s thoughts & feelings & resolving confusion

  9. Active Listening • STOP TALKING • demonstrate that you want to listen • remove distractions • be patient • STOP TALKING

  10. Techniques • Offering Self-making yourself available on an unconditional basis- “I’ll stay with you awhile” • Giving Recognition-acknowledging client’s thoughts and feelings • Sharing Observations-”You seem tense and upset” • Encouraging Descriptions-ask client to verbalize experience- “Tell me what is happening now”

  11. Techniques • Restating-repeating the main idea • Sequencing-placing events in chronological order • Reflecting-referring questions, thoughts, feelings back to client- “What do you think you should do?”

  12. Assertive Communication • “I” Statements allow people to ‘own’ (take responsibility for) their own thoughts & feelings • assertiveness involves taking a risk

  13. NONVERBAL CUES • 80-90% of any message is carried nonverbally by our body language (facial expression, paralanguage, and tone, pitch, and volume of voice

  14. NONVERBAL CUES • professional attire • sit arm’s length away • relaxed but attentive posture

  15. NONVERBAL CUES • facial expressions and tone should be friendly & interested • use direct eye contact & match your eye contact with the patient’s • pay attention to body language of the patient as well as your own

  16. INTERVIEWING TECHNIQUES • the purpose of the interview is to obtain accurate & thorough information • put your client at ease as they may feel uncomfortable about revealing sensitive information to you • explaining your format helps clients accept & understand the purpose of the interview

  17. INTERVIEWING TECHNIQUES • in general, use open-ended questions • however, to obtain specific information, closed-ended questions are preferable • validate information • clarify responses • use reflective questions/comments & paraphrasing

  18. Progression ofthe Interview • Broad Openings- such as “Tell me about yourself” are designed to allow the client to relate his or her story in a way that is comfortable

  19. Progression ofthe Interview • Open-Ended Questions encourage the client to elaborate or give explanations (for example, “What happened yesterday?”) • they provide direction & keep the conversation focused

  20. Progression ofthe Interview • Closed-Ended Questions can be answered with 1-2 words and can be useful in obtaining specific types of information, such as “What is today’s date?”

  21. EFFECTIVE INTERVIEWING • as a professional nurse, you will spend about half of your time obtaining information from clients & colleagues • excellent communication as well as interviewing skills are fundamental, yet require years of practice

  22. WHY, WHAT, HOW • why do you need the information? • how will the information I am seeking direct me in helping my client? • how will you phrase your questions?

  23. Who to Ask? • if the client is able to speak, ask him/her • family perspectives may also be important • written consent may be required to question concurrent/previous healthcare providers • be courteous and respectful • never forget client confidentiality

  24. “Why” Questions • offensive misuse of ‘why’ appears threatening and confrontational and puts clients on the defensive • they can interfere with developing a therapeutic relationship & are seldom considered therapeutic

  25. ConveyingUpsetting Information • The SPIKES Model developed by Radziewicz & Baile (2001) • Setting • Perception • Invitation • Knowledge emotions • Summary

  26. Setting • private & comfortable • invite others, such as family members

  27. Perception • refers to what client and others already know useful in uncovering misinformation

  28. Invitation • For example, the statement, “Would you like me to explain more about what happened?’

  29. Knowledge • gradually dispense information assessing client’s ability to cope with it • The family may insist that the client not be told difficult news

  30. Emotions • let client vent while you remain calm • keep in mind Stages of Grief & Loss • may need to set limits on inappropriate /harmful behavior

  31. Summary • review all important information with the client and family • may need to repeat information more than once

  32. Self-Disclosure • Use self disclosure to help clients open up to you – not to meet your own needs • Keep disclosures brief • Don’t imply that your experience is exactly the same as the client’s • Only self-disclose about situations that you have mastered

  33. Self-Disclosure • 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

  34. Therapeutic VersusNontherapeutic Communication • THERAPEUTIC - Facilitates transformation of working nurse-patient relationship - Relationship allows for adequate & accurate data collection & assessment - Performed with & not for patient

  35. Therapeutic VersusNontherapeutic Communication • NONTHERAPEUTIC - Hinders relationship formation - Prevents patient from becoming mutual partner & relegates him/her to passive recipient of care

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