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Therapeutic Communication in Psychiatric Nursing This page was last updated on January 22, 2011
INTRODUCTION
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The nurse-client relationship is the foundation on which psychiatric nursing is established. The therapeutic interpersonal relationship is the process by which nurses provide care for clients in need of psychosocial intervention. Mental health providers need to know how to gain trust and gather information from the patient, the patient's family, friends and relevant social relations, and to involve them in an effective treatment plan. Therapeutic use of self is the instrument for delivery of care to clients in need of psychosocial intervention. Interpersonal communication techniques are the ³tools´ of psychosocial intervention.

THERAPEUTIC NURSE-CLIENT RELATIONSHIP
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Therapeutic relationships are goal- oriented and directed at learning and growth promotion.

Therapeutic Use of Self
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Definition - ability to use one¶s personality consciously and in full awareness in an attempt to establish relatedness and to structure nursing interventions. Nurses must possess self-awareness, self-understanding, and a philosophical belief about life, death, and the overall human condition for effective therapeutic use of self.

Requirements for Therapeutic Relationship
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Rapport Trust Respect Genuineness Empathy

. greater height. In the transactional model. Both persons participate simultaneously.Phases of a Therapeutic Nurse-Client Relationship y y y y Pre-interaction phase Orientation/Introductory Period Working Termination INTERPERSONAL COMMUNICATION y y y Interpersonal communication is a transaction between the sender and the receiver. and customs provide the basis for ways of thinking. power dressing. both participants perceive each other. y Example: attitudes of prejudice are expressed through negative stereotyping. and simultaneously engage in the process of creating meaning in a relationship. Culture or religion y Cultural mores. CONTEXT OF THERAPEUTIC COMMUNICATION Values. listen to each other. focusing on the patients issues and assisting them learn new coping skills. Both sender and receiver bring certain preexisting conditions to the exchange that influence the intended message and the way in which message is interpreted. and beliefs. Gender y Masculine and feminine gestures influence messages conveyed in communication with others. attitudes. ideas. norms. Social status y High-status persons often convey their high-power position with gestures of hands on hips. and more distance when communicating with individuals considered to be of lower social status.

the innate tendency to own space o Density .conveys positive regard Giving recognition . if he or she so desires Accepting . indicating awareness .the distance for speaking in public or yelling to someone some distance away Nonverbal Communication: Body Language Components of nonverbal communication y y y y y y Physical appearance and dress Body movement and posture Touch Facial expressions Eye behavior Vocal cues or paralanguage THERAPEUTIC COMMUNICATION TECHNIQUES y y y Using silence . and distance are aspects of environment that communicate messages.the closest distance that individuals allow between themselves and other Personal distance -the distance for interactions that are personal in nature.the number of people within a given environmental space o Distance . density.´ and others.the means by which various cultures use space to communicate Proxemics: Use of Space y y y y Intimate distance . The environment y Territoriality. o Territoriality .allows client to take control of the discussion. with words such as ³cool.´ ³awesome.the distance for conversation with strangers or acquaintances Public distance .Age or developmental level y Example: The influence of developmental level on communication is especially evident during adolescence.acknowledging. such as close conversation with friends Social distanc .

expressing uncertainty as to the reality of client¶s perception Verbalizing the implied . or relationship Seeking clarification and validation .y y y y y y y y y y y y y y y y y Offering self .asking client to compare similarities and differences in ideas.verbalizing what is observed or perceived Encouraging description of perceptions . idea.striving to explain what is vague and searching for mutual understanding Presenting reality . experience.clarifying misconceptions that client may be expressing Voicing doubt . Discuss aspects that cannot realistically be changed and ways to cope with them more adaptively.asking client to verbalize what is being perceived Encouraging comparison .taking notice of a single idea or even a single word Exploring .putting into words what client has only implied Attempting to translate words into feelings . Discuss alternative strategies for creating changes the .clarifies the relationship of events in time Making observations .lets client know whether an expressed statement has or has not been understood Reflecting . experiences.encourages client to continue Placing the event in time or sequence .striving to prevent anger or anxiety escalating to unmanageable level when stressor recurs THERAPEUTIC COMMUNICATION AND PROBLEMSOLVING Goals are often achieved through use of the problem-solving model: y y y y Identify the client¶s problem.making oneself available Giving broad openings .delving further into a subject. Promote discussion of desired changes.allows client to select the topic Offering general leads . or interpersonal relationships Restating .directs questions or feelings back to client so that they may be recognized and accepted Focusing .putting into words the feelings the client has expressed only indirectly Formulating plan of action .

Provide positive feedback for client¶s attempts to create change. Encourage client to implement the change. E ± Establish eye contact. Several nonverbal behaviors have been designed to facilitate attentive listening. Help client evaluate outcomes of the change and make modifications as required. both verbally and nonverbally. Process Recordings y y y y Written reports of verbal interactions with clients A means for the nurse to analyze the content and pattern of interaction A learning tool for professional development How do I give a Patient Feedback Feedback is useful when it y y y is descriptive rather than evaluative and focused on the behavior rather than on the client is specific rather than general is directed toward behavior that the client has the capacity to modify imparts information rather than offers advice.y y y y y client desires to make. LISTENING TO THE PATIENT y To listen actively is to be attentive to what client is saying. y y y y y S ± Sit squarely facing the client. Nontherapeutic Communication Techniques y y Giving reassurance . R ± Relax.refusing to consider client¶s ideas or behavior . Help client select an alternative. L ± Lean forward toward the client. O ± Observe an open posture.may discourage client from further expression of feelings if client believes the feelings will only be downplayed or ridiculed Rejecting . Weigh benefits and consequences of each alternative.

causes the nurse to take over the direction of the discussion CONCLUSION y y Effective communication is the core skill in mental health care in primary care settings.to defend what client has criticized implies that client has no right to express ideas. .blocks discussion with client and avoids helping client identify and explore areas of difficulty Interpreting .results in the therapist¶s telling client the meaning of his or her experience Introducing an unrelated topic . opinions.y y y y y y y y y y y y Approving or disapproving .implies that the nurse has the right to pass judgment on whether client¶s ideas or opinions are ³right´ or ³wrong´ Giving advice .pushing for answers to issues the client does not wish to discuss causes client to feel used and valued only for what is shared with the nurse Defending . and trite expressions .asking ³why´ implies that client must defend his or her behavior or feelings Indicating the existence of an external source of power .causes client to feel insignificant or unimportant Making stereotyped comments.these are meaningless in a nurse-client relationship Using denial . or feelings Requesting an explanation .implies that the nurse knows what is best for client and that client is incapable of any self-direction Probing . clichés.implies that the nurse has the right to pass judgment on the ³goodness´ or ³badness´ of client¶s behavior Agreeing or disagreeing . Self-awareness and ability to collaborate with other health care providers are also skills that will facilitate accurate inquiry into the patient's true concerns and the context in which they occur.encourages client to project blame for his or her thoughts or behaviors on others Belittling feelings expressed .

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