Introduction to Therapeutic Communication

1. Introduction to Therapeutic Communication Nurs 200 Michelle Jocson MSN MED RN Sheryl Abelew MSN RN

2. Class Objectives Discuss elements of professional communication. Discuss the five levels of communication that nurses use in practice. Discuss therapeutic and non-therapeutic communication techniques. Identify significant features and therapeutic outcomes of nurse-client helping relationships.

3. Therapeutic Communication Is a goal directed and focused dialogue between the nurse and the client. The goal of this dialogue is fitted to the needs of the client and designed to allow the client to express themselves freely.

4. Professional Communication CONSIDER… How the nurse initially greets the client and how his/her actions can have a lasting impression on the client and the family.

5. Elements of Professional Communication Courtesy- say hello, goodbye, knock on doors, introduction, make eye contact, smile Privacy and confidentiality-safeguard the client’s rights to privacy

6. Elements of Professional Communication Autonomy-self-directed and independent accomplishing goals and advocating for others Assertiveness-often contain ‘I’ messages, feelings of security, competence, honesty

7. Five Levels of Communication Interpersonal Communication -One-one, face to face interaction between the nurse and another person Transpersonal Communication- Interaction that occurs within a person’s spiritual domain (prayer, meditation)

8. Five Levels of Communication Small-Group Communication- Interaction that occurs when a small number of people meet and share a common goal (committee, unit in-services) Intrapersonal Communication- Powerful form of communication that occurs within an individual (self-talk-nurses need to try to replace negative talk with positive thoughts) Public Communication- Interaction with an audience (requires nurses to use eye contact, gestures, etc)

9. Types of Therapeutic Communication Active Listening- attentive to what the client is saying verbally and non-verbally Share observations- make comments on how the individual looks, sounds or acts Share empathy- be sensitive to the client Share hope- convey a sense of possibility

10. Types of Therapeutic Communication Share humor- has a positive effect on an individual. Ensure the client understands what is being said Sharing feelings- help clients to share feelings by observing and encouraging communication Use touch- bring the sense of caring by holding a client’s hand Use silence- is useful in allowing the client to think and gain some insight into the situation. Listening is crucial.

11. Therapeutic Communication Techniques Ask relevant questions- ask questions one at a time, to explore the topic before going on Provide information- provide information that the client needs to know helps to empower the client Paraphrasing- by restating the client’s message, the client knows that the nurse is listening Clarifying-assess whether the client understood the information

12. Therapeutic Communication Techniques Focusing-focus on key issues in the conversation Summarizing-brings s sense of closure to the conversation Self disclosing- way of showing the client that the information is understood and shows respect for the client Confronting-help the client realize his/her inconsistencies in feelings, attitudes, or beliefs

13. NON-Therapeutic Communication Techniques Asking personal questions- asking questions that are not pertinent to the clients situation Give personal opinions-it takes the decision making power away from the client Change the subject-tends to block further communication

14. NON-Therapeutic Communication Techniques Automatic responses-shows the nurse is not taking the situation seriously False reassurance-offering reassurance not supported by facts may do more harm than good Sympathy-subjective and prevents a clear picture of the client’s situation

15. NON-Therapeutic Communication Techniques Ask for explanation-questions can cause resentment Approval or disapproval-approval/disapproval sends the message that the nurse has the right to make judgments Defensive responses-implies the client has no rights to an opinion

16. Nontherapeutic Communication Techniques Passive or aggressive responses-passive responses avoid the issues and aggressive responses maybe confrontational Arguing-implies the client is lying or misinformed

17. How is information collected from the client? Interview is a method to collect data about the client. An interview is an organized conversation with the client to obtain the client’s history and information about the current illness/

18. Types of Interview Techniques Open-ended questions- the client is able to tell his/her full story about the health problem. The nurse establishes concern about the client. Nurse may ask the client to add more information by saying: ‘Is there anything else’?

19. Types of Interview Techniques Closed-ended questions- limits the answer to one or two word such as “yes” or “no”. Used when the nurse wants to know a specific answer to a question such as: Are you experiencing pain now?

20. Types of Interview Techniques Focused questions- when there is an established, strong relationship, these questions can result in lengthier responses. Use with a resistant client. Nurse may say: Can you describe your feelings?

21. Phases of the Interview There are 3 phases which include: a) Orientation phase b) Working phase c) Termination phase

22. Orientation phase Orientation phase- the nurse introduces his/herself to the client and explains the purpose of the interview. The nurses explains why the data is being collected. The nurse needs to understand the client’s needs. Trust and confidentiality must be conveyed. Professionalism is extremely important.

23. Working Phase Working phase- the nurses asks questions to obtain data for the purpose of developing a nursing care plan. In this phase, the nurse uses such strategies as silence, listening, paraphrasing, clarifying etc. to facilitate communication.

24. Termination Phase C) Termination phase- client needs to know the interview is coming to an end. The nurse can say that there are just a few more questions to ask. The nurse summarizes the information and asks the client if this information is accurate. Note: Nurses become skilled at interviewing with experience.

25. Basic Elements of the Communication Process Referent-motivates a person to communicate with another Sender- person who sends the message and Receiver-person who receives and decodes the message Message-content of the communication Channels-means of conveying and receiving messages through visual, auditory, and tactile senses

26. Basic Elements of the Communication Process Feedback- message returned by the receiver Interpersonal Variables-factors that influence communication such as perception, interpretation, understanding Environment-the setting for the sender-receiver interaction

27. The Nursing Process and Therapeutic Communication Assessment – gather information about the client’s health condition Nursing Diagnosis-identify the client’s health problem (s) Planning- establish goals, desired outcomes and identify appropriate nursing actions Implementation- carries out the nursing actions Evaluation- determines if client goals were met and outcomes achieved