Submitted by E. Shaifer RN MSN

COMMUNICATION & THERAPUTIC COMMUNICATION Submitted by E. Shaifer RN MSN

INTRODUCTION • Nurses interact with many people daily • Success depends upon effective interpersonal skills “The quality of care you provide is dependant on the quality of communication that exists between you and your patient”

OBJECTIVES • Describe the major purpose of communication among health practitioners • Identify components of communication • Describe verbal and nonverbal behaviors that affect communication • Describe the techniques which facilitiate communication • Describe techniques which block communication

The Communication Process Claude Shannon & Warren Weaver Communication Model (1949)

Encoder (sender) initiates exchange of ideas, thoughts & feelings) Message (the content to transmit to another) Sensory Channels (ways sent: visual auditory & kinesthetic-tone of voice, wink, hand gesture Decoder (to whom message is aimed-must be able to decode) Context-(condition under which communication occurs i.e., therapeutic relationship Feedback (to determine effectiveness of communication). Shannon& Weaver-Six Elements Communication Process

Communication Process “You seem distracted today” (Message) sensory Auditory route “I’m in so much pain…” Feedback Nurse (Encoder) Client (Decoder)

Purpose Of Communication • Send/receive information • Influence others • Interpret • Respond • Interchange of Information • Role as advocate/change agent

Language/Spoken Words Writing-transfer a thought in print form Exchange of Words Accompanied by nonverbal expressions KINDS OF COMMUNICATION:VERBAL

KINDS OF COMMUNICATION:NONVERBAL BODY LANGUAGE • Personal Appearance (judged) • Facial expressions (eyes, smile, grimaces,frown,sadness, happiness) • Body Posture (posture and stance) • Gestures (hands talking, emotional coping) • Personal Distance (private zone can be cultural) • Touching (cultural, always assess first/ask permission)

TYPES OF COMMUNICATON • THERAPUTIC: ~effective, planned & conscious ~goal-oriented • NON-THERAPUTIC: ~not Therapeutic

FACTORS INFLUENCING COMMUNICATON • Culture • Perceptions and values - • Social class • Relationships • Setting • Content of the message • Toxic vs. non-toxic words

FACTORS INFLUENCING COMMUNICATON-2 • Ability of individual to send & receive messages • Perceptions of sender & receiver • Personal space/social distances • Territoriality • Roles and Relationships • Time Environment • Attitudes • Emotions and Self-Esteem

WHAT IS THERAPUTIC COMMUNICATON? An interpersonal interaction between the nurse/client in which the nurse focuses on the client’s specific needs to promote an effective exchange of information. HOW DOES IT HELP THE NURSE? • Identify the most important client concern at that moment (client-centered goal). • To interact with client. • Facilitate expression of emotions (client). • Implement interventions designed to address the client’s needs. (NCP,Process Recording)

Offering self Reflection Facilitative Questions and Statements Giving Recognition Clarifying Conveying Information Stating Observation Silence Presenting Reality Summarizing *Examples to follow THERAPUTIC COMMUNICATIONAKA :INTERPERSONAL TECHNIQUES

OFFERING SELF Example: Nurse:" I'll sit with you a while”

Reflection • Pt: “I’m so discouraged. I thought I would be home from the hospital today.” • Nurse: “You sound upset that you’re not going home today.”

Facilitative Questions and Statements (Broad Open-ended) • Encourage patients to answer in their own words • *Broad open ended questions “What brought you to the hospital? “Describe how you feel about this? • Closed-ended questions(can become a “broken record”) “how long?” “can you explain” “are you worried about the results?”

GIVING RECOGNITION • Nurse: “Good Morning Mrs. S., I noticed that you combed your hair.”

CLARIFYING • Pt: “During certain activities, I have the most awful pain in my back” • Nurse: “Tell me what you mean by awful”

CONVEYING INFORMATION • Pt: “I feel nauseous and have diarrhea. Why do I feel so sick?” • Nurse: “You may be having a side effect from the lithium you are taking. We should check your level.”

MAKING OBSERVATIONS • Nurse: “You seem upset when talking about your relationship with your mother” • Pt: “Yes, I’ve been estranged from her since the death of my father, whom I was very close to.”

USING SILENCE • Usually not comforting socially • Conveys acceptance, support, and concern. • Allows patient to organize thoughts or reflect.

PRESENTING REALITY • Patient:” I hear sirens wailing in my ears to warn me, the aliens are coming.” • Nurse:” It must be frightening for you to hear sirens wailing, butI don’t hear anything.”

SUMMARIZING • Pt: “I know drinking doesn’t really help me in the long run. And it sure doesn’t help my family. My wife keeps threatening to leave. I know all this, but it’s hard to stay away from the booze. Having a drink makes me feel relieved.” • Nurse: “During the past 30 minutes, you and I have discussed some of the ways that drinking is not very helpful to your life yet you feel better, less overwhelmed, after a drink…”

BARRIERS/BLOCKS TO COMMUNICATION • Giving advice (“what you should do is”…) • Giving false reassurance (“Everything will be alright…don’t worry, lots of people have this surgery) • Argumentative (“Just go on and go to group. Get outta my hair.”) • Challenging (If you’re dead, why is your heart beating?”) • Disagreeing with the Patient (“You’re wrong", "that's not true” • Making stereotypical comments- (clichés, “keep your chin up”,etc.)

PATIENT WITH SPECIAL NEEDS Hearing impaired patient • Check to see if the patient wears a hearing aid • Be sure it is working • Minimize background noise • Always face the patient • Speak with a normal tone and pace • Does the patient use sign language? • Pay attention to non verbal communication from you and the patient • Use a pen and paper if necessary

PATIENT WITH SPECIAL NEEDS-2 • Visually impaired • Use a normal tone and pace • Look at and speak to the patient • Tell the patient when you leave and enter the room • Orient the patient to the immediate area • Ask for permission before touching the patient

PATIENT WITH SPECIAL NEEDS-3 • Speech Impaired/ Aphasic • Assess how well the patient communicates • Adapt to the patients ability for communication • Allow time for the patient to respond • Don’t answer questions for the patient • Use closed questions when possible • Repeat or rephrase questions when needed • Speak directly to the patient, not and intermediary

PATIENT WITH SPECIAL NEEDS-5 • The emotional patient • Emotions are neither good or bad • Actions based on emotion can be good or bad • Allow the patient or family member to express their emotion • Let them know it is OK to express emotion a. when a person is angry b. recognize and acknowledge that anger c. bring it to their attention, give permission

Helping and personal Client-focus Aimed at mutual goals Develop and evolve over time Establish trust and honesty Empathy Establish trust and honesty (“I cannot promise that I can help solve your problem, but I listen and I do care.” Communication is the meaningful interaction between the two of you that leads to such growth. Maintain client confidentiality Be aware of cultural differences TECHNIQUES FOR ESTABLISHING A HELPING RELATIONSHIP

PROCESS RECORDING What is a Process Recording? A written account of verbal interactions with clients…recorded verbatim. Usually verbal and non-verbal communication of nurse and client. A learning tool which aids the student to develop observation and communication skills. Help the patient express feelings and solve a current problem.

REFERENCES • Harkreader,H.,Hogan.(2004).Fundamentals of nursing: Caring and clinical judgment.(2nd ed.). St. Louis, MO: Sanders. • Townsend, M.(2005). Essentials of psychiatric mental health nursing. (3rd ed.). Philadelphia, PA: F.A.Davis. • Therapeutic Communication.(n.d.).Retrieved August 30, 2007, from Mount Saint Mary’s College. http://faculty.msmc.edu /zychowic/therapeutic %20communication files/frame.htm

THANK YOU! QUESTIONS

Submitted by E. Shaifer RN MSN