THERAPEUTIC COMMUNICATION

Janice A. Aloi, DMH, RN, CNE

Communication

The basic element of human interaction A complex process An important element of nursing practice Requires a conscious application of

principles

LEVELS

Intrapersonal Communication – occurs within an individual.

Interpersonal Communication – face-to-face interaction between two people or a small group.

FACTORS THAT INFLUENCE COMMUNICATION

PERCEPTIONS VALUES DEVELOPMENT SPACE AND TERRITORIALITY EMOTIONS SOCIOCULTURAL BACKGROUND KNOWLEDGE ROLES AND RELATIONSHIPS ENVIRONMENTAL SETTING

VERBAL COMMUNICATION

Denotative Connotative Intonation Decoding Feedback

Nonverbal Communication-the exchange of messages without the use of words

Facial expression Eye contact Gestures Posture and gait Touch Space and Territoriality

Therapeutic Communication

Fosters an exchange between parties

Has a goal or purpose in mind

Non-therapeutic Communication

Hinders the exchange

THERAPEUTIC COMMUNICATION

OCCURS IN THE CONTEXT OF THE NURSE-CLIENT RELATIONSHIP

NURSE-CLIENT RELATIONSHIP

A dynamic interactive process between a professionally educated person, the nurse, who helps another individual, the client, to seek and use help.

– The relationship is productive– Involves verbal and nonverbal communication– An exchange of thoughts and feelings that

facilitate healing

PROBLEM-SOLVING METHOD

Identify the client’s problem Promote discussion of desired changes. Identify realistic changes. Discuss alternative strategies for creating changes and ways to

cope with aspects that cannot be realistically changed. Weigh benefits and consequences of each alternative. Assist client to select an alternative. Support client’s effort to implement strategy. Assist the client to evaluate outcomes of the change and make

modifications as required.

ESSENTIAL INGREDIENTS

RAPPORT

TRUST

RESPECT

GENUINENESS

EMPATHY

PHASES OF THE NURSE-PATIENT RELATIONSHIP

PREORIENTATION

ORIENTATION

WORKING

TERMINATION

CONCERNS OF THE NURSE

FEAR OF REJECTION FEAR OF EXPLOITING THE CLIENT FEAR OF HELPLESSNESS FEAR OF PHYSICAL AGGRESSION FEAR OF MENTAL ILLNESS

CONCERNS OF THE CLIENT

THREAT TO SELF-IMAGE FEELINGS OF HELPLESSNESS FEELINGS OF INCOMPETENCE FEELINGS OF INADEQUACY AFRAID OF BEING STIGMATIZED AFRAID OF CHANGE

RELATIONSHIP ISSUES

RESISTANCE - ANGER

TRANSFERENCE

COUNTERTRANSFERENCE

TRANSFERENCE

AN INTERPERSONAL EXPERIENCE IN WHICH FEELINGS, ATTITUDES, AND WISHES ORIGINALLY LINKED WITH SIGNIFICANT OTHERS IN ONE’S LIFE ARE ATTRIBUTED TO OTHERS WHO REPRESENT THESE PEOPLE IN THE CURRENT SITUATION.

COUNTERTRANSFERENCE

A CONSCIOUS OR UNCONSCIOUS RESPONSE OCCURRING IN THE NURSE OR THERAPIST IN RESPONSE TO THE CLIENT. Wishes and conflicts originating in the helper’s own relationships with significant others are transferred onto the client. Self-awareness is important for recognizing countertransference reactions.

EFFECTIVE COMMUNICATION TECHNIQUES

Broad openers Paraphrasing Making an observation Exploring Clarifying Focusing Reflecting feelings Giving info Placing events in time sequence Encouraging a plan of action Testing discrepancies Voicing doubt Summarizing

NONTHERAPEUTIC RESPONSES

False reassurance Social responding Moralizing Interpreting Giving advice Demanding an explanation Expressing approval or disapproval Belittling feelings Making stereotypical comments Failing to listen Making personal statements

DECISION-MAKING

INDIVIDUAL

LINEAL

COLLATERAL

SUMMARY

The nurse-patient relationship is a dynamic interactive process between the nurse and the patient.

The relationship is productive. It involves the use verbal and non-verbal

skills of therapeutic communication by the nurse..