Professional Documents
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NURSING DEPARTMENT
Course No. NCM 117 Lecture
Subject: Care of Client with Maladaptive Patterns of Behavior, Acute and Chronic
Yr. Level: BSN 3
Contact Hours/Credit Units: 4 fours/week(4units)_____________________________________
CHAPTER 5
THERAPEUTIC COMMUNICATION
l. Introduction
Therapeutic communication is the foundation of the nurse-patient relationship. It has a specific purpose
within the healthcare context. It is intended to develop an effective interpersonal nurse-patient relationship
that supports the patient well-being, ensures holistic, client-centered, and quality care.
COMMUNICATION:
Communication involves the giving and receiving of information.
Three elements of communication:
1. the sender
2. the message
3. the receive.
The sender creates the message and sends the message to a receiver or a listener who then decodes it.
The receiver may now return a message to the initiator of the message.
THERAPEUTIC COMMUNICATION:
An interpersonal interaction between the nurse and the patient which focuses on the specific
needs of the patient.
Proxemics – it is the study of the distance zone between two people communicating.
4 DISTANCE ZONE: (Invisible boundary)
a. intimate (0-18 in.)
b. personal (18-36 in.)
c. social (4-12 ft.)
d. public (12-25ft)
4. Touch – it is a process of holding a person, to comfort and support them when it is permitted.
TYPES OF TOUCH:
a. functional - professional
b. social - polite
c. friendship - warmth
d. love - intimacy
e. sexual - arousal
2 TYPES OF COMMUNICATION:
1. Verbal
2. Nonverbal
LEVELS OF COMMUNICATION:
1. Intrapersonal
2. Interpersonal
3. Public
CUES:
This is a non verbal and verbal message that gives us hint or suggestion from the patient.
Overt cues: It is a clear statement of what the patient intended to do.
Covert cues: Vague or hidden messages which the nurse needs to interpret.
NONVERBAL COMMUNICATION:
1. Facial expression
3 CLASSIFICATIONS:
a. expressive
b. impassive
c. confusing
2. Body language
2 CLASSIFICATIONS:
a. close body position
b. accepting body position
3. Eye contact
a. visual learners are those who learn best by seeing things.
b. auditory learners are those who learn best by hearing.
c. kinesthetic learners are those who best by doing things.
4. Vocal cues or paralanguage: refers to how something is said rather than what is said.
This includes the:
volume (loudness)
tone (quality)
pitch (high/low)
intensity (strength/importance)
emphasis (accent)
speed and pause
SPEECH PATTERNS:
1. Circumstantiality - It is a speech with a long-winded description.
2. Pressured speech - It is a long talking wherein the patient doesn’t want to be interrupted. Slowly and
ceremonious delivery.
Crying:
Stay with the client: reinforce that it is alright to cry.
Suicidal/Elope
Consider the seriousness of the situation,
inform the client about the harm that can happen and the need to be reported.
Suicidal/Elope
Consider the seriousness of the situation,
inform the client about the harm that can happen and the need to be reported.
NONTHERAPEUTIC TECHNIQUE
TECHNIQUE EXAMPLE
1. REASSURING • Don’t worry everything will be alright.
2. GIVING APPROVAL • That’s good…
3. REJECTION • Let us not discuss that.
4. ADVISING • I think you should or If I were you…
5. PROBING • Come on, tell me more about your husband.
6. CHALLENGING • If you are not crazy, how come you are in the hospital.
7. TESTING • What day is today, do you know?
8. DEFENDING • For sure, no one here would lie to you.
9. REQUESTING AN EXPLANATION • Why did you do that?
10. BELITTLING FEELINGS EXPRESSED • Patient: I wish I was dead. Nurse: I know what you mean, I feel that
way sometimes.
11. MAKING STEREOTYPICAL COMMENT • It is for your own good or I’m fine, how are you.
12. OVERLOADING • What’s your name? I see you are busy. How are you?
13. VALUE JUDGMENTS • You should not do that. It’s wrong.
14. INCONGRUENCE • I like to spend time with you, but the nurse walks away.
15. UNDERLOADING • The patient asks but the nurse would just keep quiet.
16. FALSE ASSURANCE • Just be calm and everything will be alright.
17. FOCUSING ON SELF • I like the color of this shirt, it is fits to my complexion.
18. CHANGING THE SUBJECT • Patient: I am worried with the result of my blood exam. Nurse: How are
you related to that lady.
19. LOOKING TOO BUSY/IGNORING THE PATIENT • I have a lot of things to do at present.
20. ARGUING • I know I am right and you are wrong.
21. SHOWING A CLOSE POSTURE • Crossing of legs and arms on chest.
22. MAKING FALSE PROMISES • I will visit you tomorrow, but nurse failed to.
23. DISAPPROVING • That’s not the way how it is done.
24. LAUGHING NERVOUSLY or inappropriately
IV. Activity:
Long Quiz
V. Bibliography:
Prepared by: