“Therapeutic Communication

To Patients”

Lecture Support :
Lilis Maryanti, S.Pd, M.Pd
Group 7
1. M. Zulfa R. (PO7120119055)
2. Mayang Kartika (PO7120119057)
3. Miftha Huljannah (PO7120119059)
4. Ria novita sari (PO7120119078)

Class 2B
 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 communication

Interactive verbal and non-verbal strategies that

focus on the needs of patients and facilitate a goal-
directed, patient-oriented communication process.
Therapeutic communication is often time limited.

 Therapeutic listening

Listening that is focused on patients and obtains

therapeutically useful information about patients.
 TYPES OF COMMUNICATION

 Verbal

 Environment

 Nonverbal

 Electronic
 CONTENT AND PROCESS
 Content: the explicit words spoken, the
substantive issues, the “what”.. The overt
meaning of the communication.

 Process: a process-oriented focus is

concerned with the “how” or “why” verbal
content is communicated, or the covert
meaning.
METACOMMUNICATION: the communication about
communication, a message about the nature of the
relationship between the two interacting individuals.
METACOMMUNICATION: the communication about
communication, a message about the nature of the
relationship between the two interacting individuals.

 “close the window!”

 “wouldn’t you like to close the window? You must

be cold.”

 “I’m cold, would you please close the window?”

 “Why is this window open?”

Factors that influence communication
 Gender
 Culture
 Personal/life experiences
 Feelings
 Beliefs
 Attitudes
 Self-concept
 Socioeconomic status
 THE ROLE OF
SELF-AWARENESS
“Know thyself” (Boyd, 2002)

Self awareness is the process of understanding

one’s own beliefs, thoughts, motivations,
biases, and limitations and recognizing how
they affect others.
 Therapeutic Social communication

Purpose To meet the needs of Personal enjoyment of both

the patient. parties, both parties seek to
get personal needs met.

Planned and directed by Both parties may share

Content the professional to emotional and personal
meet patient needs. information.
Important for
professional to maintain
objective professional
distance

Sharing information is If parties are friends,

Expectations on a need-to-know basis shared feelings and
with other professional emotional material are
team members. assumed to be confidential.
THERAPEUTIC USE OF SELF

 Sensitivity … to recognize important cues

and make decisions about the priority of
the cues.
 Objectivity …openness to patients,
problems, and solutions; must be aware of
own reactions and bias’
 Empathy … objectively recognize,
understand and communicate patients’
feelings to patient ; “communicating
understanding”
Therapeutic techniques
Description  Identifying themes
 Offering self  Summarizing
 Active listening Problem solving & Decisions
 Silence  Suggesting collaboration
 Empathy  Encourage goal setting
 Questioning  Providing information
 General leads  Encouraging decisions and
 Restating consideration of options
 Verbalizing the implied  Formulating plan
 Clarification Completion of plans
Analysis & Conclusions  Testing out new behaviors
 Making observations  Supportive confrontation
 Presenting reality  Limit setting
 Encouraging description of  Feedback
perceptions Evaluation
 Voicing doubt  Encouraging evaluation
 Placing an event in time or  Reinforcement
sequence
 Encouraging comparisons
 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
APPLICABLE NURSING DIAGNOSIS

 Impaired Social Interaction (insufficient or excessive quantity

or ineffective quality of social interaction)

 Impaired Verbal Communication (decreased, delay, or absent

ability to receive, process, transmit and use a system of
symbols)

Nursing intervention (depends on the etiology and manifestation)

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

 A patient has been withdrawn and suspicious since admission. He is

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

 A patient has been withdrawn and suspicious since admission. He is

wary of staff and other patients. An example of appropriate use of
touch with this patient is……

 The nurse tells a patient, “I noticed that you seemed to become

irritated when we discussed your relationship with your husband.”
The nurse is using the communication technique known as:
Case scenarios……
 During a one-to-one interaction with the nurse, a patient frequently
looks nervously at the door. What might your response be? What
therapeutic technique is this?

 A patient has been withdrawn and suspicious since admission. He is

wary of staff and other patients. An example of appropriate use of
touch with this patient is……

 The nurse tells a patient, “I noticed that you seemed to become

irritated when we discussed your relationship with your husband.”
The nurse is using the communication technique known as…

 You realize you have just made an insensitive remark to a patient.

How might you respond to the patient in a therapeutic manner?
Case scenarios……

 A patient who is scheduled to attend a number of treatment

groups becomes angry and complains, “I’m really ticked about
having to attend all those groups. No one else spends all day in a
circle in a little tiny room.” How might you respond to this
patient? What therapeutic technique are you using?
 NURSE-PATIENT
RELATIONSHIP
Objectives:

 To identify goals of the nurse-patient relationship

 To identify and discuss the stages of the nurse-

patient 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
NURSE-PATIENT
RELATIONSHIP
Stages of the nurse-patient relationship
*planned, patient centered and goal directed*

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

 Stage I: Pre-Orientation
 Stage II: Orientation
 Stage III: Working Stage
 Stage IV: Termination
 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
case scenarios….
 John S. is suspicious, denying his illness, and hyperactive. 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. 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, “I

feel really close to you. You’re the only true friend I have.” The
most therapeutic response for the nurse to make is:
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. They don’t seem
like a worthwhile use of nursing time.” 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.
THANK YOU