Therapeutic Technique | Nonverbal Communication | Patient

Therapeutic Technique 1. Offering Self • • making self-available and showing interest and concern.

“I will walk with you”

2. Active listening • • paying close attention to what the patient is saying by observing both verbal and non-verbal cues. Maintaining eye contact and making verbal remarks to clarify and encourage further communication.

3. Exploring • “Tell me more about your son”

4. Giving broad openings • What do you want to talk about today?

5. Silence • Planned absence of verbal remarks to allow patient and nurse to think over what is being discussed and to say more.

6. Stating the observed • • verbalizing what is observed in the patient to, for validation and to encourage discussion “You sound angry”

7. Encouraging comparisons • • • asking to describe similarities and differences among feelings, behaviors, and events. • “Can you tell me what makes you more comfortable, working by yourself or working as a member of a team?”

8. Identifying themes • • asking to identify recurring thoughts, feelings, and behaviors. “When do you always feel the need to check the locks and doors?”

9. Summarizing • • reviewing the main points of discussions and making appropriate conclusions. “During this meeting, we discussed about what you will do when you feel the urge to hurt your self again and this include…”

10. Placing the event in time or sequence • • asking for relationship among events. “When do you begin to experience this ticks? Before or after you entered grade school?”

11. Voicing doubt • • voicing uncertainty about the reality of patient’s statements, perceptions and conclusions. “I find it hard to believe…”

12. Encouraging descriptions of perceptions • asking the patients to describe feelings, perceptions and views of their situations.

Presenting reality or confronting • • • stating what is real and what is not without arguing with the patient. 21. “I know you hear these voices but I do not hear them”. . “How did you feel when the doctor told you that you are ready for discharge soon?” 20. Patient: I think I should leave now. Nurse: Are you thinking of killing yourself? 16. General leads • • • using neutral expressions to encourage patients to continue talking. “I am not familiar with your work. Verbalizing the implied • • • rephrasing patient’s words to highlight an underlying message to clarify statements. “Let us talk more about your best friend in college” “You were saying…” 22. “It’s hard to begin to live alone when you have been married for more than thirty years”. Patient: I wont be bothering you anymore soon. elaborate. Restating • • • repeating the exact words of patients to remind them of what they said and to let them know they are heard. 14. Patient: I always take this towel wherever I go.• “What are these voices telling you to do?” 13. or give examples of ideas or feelings to seek clarification of what is unclear. your nurse. Nurse: Do you think you should leave now? 17. “I am Lhynnelli. Nurse: That towel must always be with you. I stay awake all night. 15. Reflecting • • • throwing back the patient’s statement in a form of question helps the patient identify feelings. Focusing • • • pursuing a topic until its meaning or importance is clear. Nurse: You can’t sleep at night? 18. “I don’t think I understand what you are saying”. Empathy • • recognizing and acknowledging patient’s feelings. Seeking clarification • • • asking patient to restate. can you describe it further for me”. “Go on…” “You were saying…” 19. and this is a hospital and not a beach resort. Asking question • • using open-ended questions to achieve relevance and depth in discussion. Interpreting • • • providing a view of the meaning or importance of something. Patient: I can’t sleep.

“I’ll play your mother. Supportive confrontation • • acknowledging the difficulty in changing. “Supposing you meet these people again. Feedback . “Given all these choices. “Have you thought of the possible effects of your decision to you and your family?” 29. Role playing • • practicing behaviors for specific situations. “What do you think led the court to commit you here?” “Can you tell me the reasons you don’t want to be discharged? 24. 25. 28. Suggesting collaboration • • offering to help patients solve problems. “What do you think about the things you have to change in your self?” 26. 30. Encouraging decisions • • asking patients to make a choice among options.23. what would you prefer to do. Giving information • • providing information that will help patients make better choices. “If you decide to leave home when your husband beat you again what will you do next?” 27. 33. “Please stop now. If you don’t. Encouraging evaluation • • • asking for patients views of the meaning or importance of something. 31. “Nobody deserves to be beaten and there are people who can help and places to go when you do not feel safe at home anymore”. 34. You feel rejected when your children sent you here but if you look at this way…” 32. and encouraging productive ones. tell me exactly what would you say when we meet on Sunday”. Encouraging formulation of a plan of action • • probing for step by step actions that will be needed. Limit setting • • discouraging nonproductive feelings and behaviors. I will ask you to leave the group and go to your room. both the nurse and patient play particular role. Encouraging goal setting • • asking patient to decide on the type of change needed. “I understand. how would you respond to them when they ask you to join them for a drink?”. Encouraging consideration of options • • asking patients to consider the pros and cons of possible options. Rehearsing • • asking the patient for a verbal description of what will be said or done in a particular situation. but pushing for action. “Perhaps you can discuss this with your children so they will know how you feel and what you want”.

Where do you live?” 2. and asking for more information than can be absorbed at one time. 4. 4. “right”. simply walks away. not picking up cues. “What’s your name? I see you like sports. Underloading • • remaining silent and unresponsive. “bad”. False reassurance/ agreement • • Using cliché to reassure client. 6. Client: How are you? Nurse responds: I can’t talk now. Giving advise Talking about your self Telling client is wrong Entering into hallucinations and delusions of client False reassurance Cliché Giving approval Asking WHY? Changing subject Defending doctors and other health team members. 35. Invalidation • • • Ignoring or denying another’s presence. 6. “It’s going to be alright”. . Value Judgments • • giving one’s own opinion. 7. 10. 36. “should” and “ought”. Reinforcement • • giving feedback on positive behaviors. thought’s or feelings. evaluating. Encouraging evaluation • • asking patients to evaluate their actions and their outcomes. moralizing or implying one’s values by using words such as “nice”. “wrong”. changing subjects too often. 2. and failing to give feedback. 3. The nurse tells the patient “I’d like to spend time with you” and then walks away. its wrong”. Incongruence • • sending verbal and non-verbal messages that contradict one another. 8. 9. “You shouldn’t do that. “What did you feel after participating in the group therapy?”. “Everyone was able to give their options when we talked one by one and each of waited patiently for our turn to speak”. The patient ask the nurse. Overloading • • talking rapidly. “I see you combed your hair today”. 5. 5. I’m too busy.• • pointing out specific behaviors and giving impressions of reactions. Non-therapeutic Technique 1. 3. Avoid pitfalls: 1.

“If I were you… Or it would be better if you do it this way…” 10. Avoiding sensitive topics Arguing and telling the client is wrong Having a closed posture-crossing arms on chest Making false promises – I’ll make sure to call you when you get home. Giving advice • • telling the client what to do. 8. 12. 11. Focusing on self • • responding in a way that focuses attention to the nurse instead of the client. Requesting an explanation – Why did you do that? Reflecting – You are not suppose to talk like that! Literal responses – If you feel empty then you should eat more. implies client cannot handle his or her own life decisions and that the nurse is accepting responsibility. The client is crying. “This sunshine is good for my roses. 10. Looking too busy. Internal validation • • making an assumption about the meaning of someone else’s behavior that is not validated by the other person (jumping into conclusion). 15. Defending – Your doctor is very good. 4. 13. Ignoring the patient – I can’t talk to you right now Making sarcastic remarks Laughing nervously Showing disapproval – You should not do those things. 5. The nurse sees a suicidal clients smiling and tells another nurse the patient is in good mood. Other ineffective behaviors and responses: 1. I have beautiful rose garden”.7. a pattern that may indicate anxiety. Appearing uncomfortable in silence. 14. 8. Being opinionated. Changing the subject • • • introducing new topic inappropriately. giving opinions or making decisions for the client. when the nurse asks “How many children do you have?” 9. 7. 9. 6. 3. . 2.

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