THERAPEUTIC COMMUNICATION

Lecture objectives: To understand communication as a nursing skill To distinguish between social and therapeutic communication To identify the goals of therapeutic communication To discuss the critical issues of therapeutic communication To identify and describe techniques that facilitate patient-centered therapeutic communication To identify common causes that interfere with therapeutic communication

THE GOALS OF COMMUNICATION IN PSYCHIATRIC NURSING
 To understand the patient  To ensure that the patient understands the nurse  To teach the patient how to communicate more effectively in order to interact with society in a meaningful way and get there needs met

 Therapeutic listening Listening that is focused on patients and obtains therapeutically useful information about patients. patient-oriented communication process. Therapeutic communication is often time limited. Therapeutic communication Interactive verbal and non-verbal strategies that focus on the needs of patients and facilitate a goaldirected. .

TYPES OF COMMUNICATION  Verbal  Environment  Nonverbal  Electronic .

CONTENT AND PROCESS  Content: the explicit words spoken. or the covert meaning.. the substantive issues. . The overt meaning of the communication.  Process: a process-oriented focus is concerned with the “how” or “why” verbal content is communicated. the “what”.

METACOMMUNICATION: the communication about communication. a message about the nature of the relationship between the two interacting individuals. .

METACOMMUNICATION: the communication about communication. would you please close the window?”  “Why is this window open?” .  “close the window!”  “wouldn’t you like to close the window? You must be cold. a message about the nature of the relationship between the two interacting individuals.”  “I’m cold.

Factors that influence communication         Gender Culture Personal/life experiences Feelings Beliefs Attitudes Self-concept Socioeconomic status .

THE ROLE OF SELF-AWARENESS “Know thyself” (Boyd. thoughts. biases. . 2002) Self awareness is the process of understanding one’s own beliefs. and limitations and recognizing how they affect others. motivations.

Expectations .Therapeutic Purpose To meet the needs of the patient. shared feelings and emotional material are assumed to be confidential. Content Planned and directed by Both parties may share the professional to emotional and personal meet patient needs. Social communication Personal enjoyment of both parties. If parties are friends. information. both parties seek to get personal needs met. Important for professional to maintain objective professional distance Sharing information is on a need-to-know basis with other professional team members.

Objectivity …openness to patients.THERAPEUTIC USE OF SELF  Sensitivity … to recognize important cues and make decisions about the priority of the cues. “communicating understanding”   . understand and communicate patients’ feelings to patient . and solutions. problems. must be aware of own reactions and bias’ Empathy … objectively recognize.

Therapeutic techniques Description  Offering self  Active listening  Silence  Empathy  Questioning  General leads  Restating  Verbalizing the implied  Clarification Analysis & Conclusions  Making observations  Presenting reality  Encouraging description of perceptions  Voicing doubt  Placing an event in time or sequence  Encouraging comparisons  Identifying themes  Summarizing Problem solving & Decisions  Suggesting collaboration  Encourage goal setting  Providing information  Encouraging decisions and consideration of options  Formulating plan Completion of plans  Testing out new behaviors  Supportive confrontation  Limit setting  Feedback Evaluation  Encouraging evaluation  Reinforcement .

BARRIERS TO EFFECTIVE COMMUNICATION  Factors related to the RN  Factors related to the client .

WHAT TO AVOID  avoid excessive questions  avoid giving advice  avoid giving false reassurance  avoid requesting and explanation avoid giving approval .

process. or absent ability to receive. transmit and use a system of symbols) Nursing intervention (depends on the etiology and manifestation) .APPLICABLE NURSING DIAGNOSIS  Impaired Social Interaction (insufficient or excessive quantity or ineffective quality of social interaction)  Impaired Verbal Communication (decreased. delay.

a patient frequently looks nervously at the door. What might your response be? What therapeutic technique is this? .Case scenarios……  During a one-to-one interaction with the nurse.

What might your response be? What therapeutic technique is this?  A patient has been withdrawn and suspicious since admission. An example of appropriate use of touch with this patient is…… . a patient frequently looks nervously at the door. He is wary of staff and other patients.Case scenarios……  During a one-to-one interaction with the nurse.

a patient frequently looks nervously at the door. He is wary of staff and other patients. “I noticed that you seemed to become irritated when we discussed your relationship with your husband.Case scenarios……  During a one-to-one interaction with the nurse. An example of appropriate use of touch with this patient is……  The nurse tells a patient. What might your response be? What therapeutic technique is this?  A patient has been withdrawn and suspicious since admission.” The nurse is using the communication technique known as: .

“I noticed that you seemed to become irritated when we discussed your relationship with your husband.Case scenarios……  During a one-to-one interaction with the nurse. How might you respond to the patient in a therapeutic manner? . He is wary of staff and other patients. a patient frequently looks nervously at the door. An example of appropriate use of touch with this patient is……  The nurse tells a patient.” The nurse is using the communication technique known as…  You realize you have just made an insensitive remark to a patient. What might your response be? What therapeutic technique is this?  A patient has been withdrawn and suspicious since admission.

” How might you respond to this patient? What therapeutic technique are you using? . No one else spends all day in a circle in a little tiny room. “I’m really ticked about having to attend all those groups.Case scenarios……  A patient who is scheduled to attend a number of treatment groups becomes angry and complains.

NURSE-PATIENT RELATIONSHIP Objectives:  To identify goals of the nurse-patient relationship  To identify and discuss the stages of the nursepatient relationship  To identify the major tasks in each stage of the nurse-patient relationship .

 Goals of the therapeutic nurse-client relationships: • to enhance client well-being • to promote recovery • to support the self-care functioning of the client .

patient centered and goal directed*     Stage I: Stage II: Stage III: Stage IV: Pre-Orientation Orientation Working Stage Termination .NURSE-PATIENT RELATIONSHIP Stages of the nurse-patient relationship *planned.

patient centered and goal directed*     Stage I: Stage II: Stage III: Stage IV: Pre-Orientation Orientation Working Stage Termination .NURSE-PATIENT RELATIONSHIP Stages of the nurse-patient relationship *planned.

INTERACTIONS WITH SELECTED BEHAVIOR  Violent behavior  Hallucinations  Delusions  Conflicting values  Incoherent speech patterns  Manipulation  Crying  Sexual advances/inappropriate touch  Denial and lack of cooperation  Depressed affect  Suspicious  hyperactivity .

 Transference occurs when a client takes the perceptions and expectations of one person and projects them onto another person (usually the care provider)  Countertransference occurs when a nurse or care provider takes the perceptions and expectations of one person and projects them onto another person .

 Transference occurs when a client takes the perceptions and expectations of one person and projects them onto another person (usually the care provider)  Countertransference occurs when a nurse or care provider takes the perceptions and expectations of one person and projects them onto another person .

and hyperactive. Knowing that the patient will be discharged after a short stay what might be your main goals… how does this affect how you move through the stages of the therapeutic relationship?  A 27-year old patient with schizophrenia says to the nurse.” The most therapeutic response for the nurse to make is: .case scenarios…. “I feel really close to you. What combination of nursing interventions would you use in working with him?  Does it matter what stage your nurse-patient relationship is?  A patient is admitted to an inpatient psychiatric unit for severe depression. denying his illness.  John S. You’re the only true friend I have. is suspicious.

” How might you respond to your peer?  Describe a strategy that would be useful when the nurse finds that his/her values and the patient’s values are in conflict. They don’t seem like a worthwhile use of nursing time. .case scenarios….  A fellow nursing student says to you: “I can’t get used to doing things like playing cards or having a unit party.

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