Chapter 6 Therapeutic Communication

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

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

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

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

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.

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

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

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)

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

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

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

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

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

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

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

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

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.

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

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)

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

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

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

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

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

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