1. Chapter 6 Therapeutic 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.)
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