The Chronic

Care Nurse
Specialist
Different verbal and nonverbal
therapeutic communication skills
Start Up:
• Communication in general is process of sending and receiving
messages that enables humans to share knowledge, attitudes, and
skills.
Lesson Objectives:
• Add all the learning objectives that trainees should learn through this lesson *use the lesson plan
to support the lesson presentation*
• By the end of this interactive discussion, you will be able to:
• 1 Define the verbal and nonverbal communication
• 2 List types of Relationships.
• 3 Define therapeutic/professional communication
• 4 Discuss therapeutic nurse patient relationship.
• 5 Differentiate phases of therapeutic relationship.
Communication
• Communication in general is process of sending and receiving
messages that enables humans to share knowledge, attitudes, and
skills.
Communication is composed of two dimensions:
• Verbal and nonverbal communication
 Effective Communication

• Effective communication occurs when the receiver

understands the message as the sender intended

• Unfortunately, ineffective communication often

occurs due to some barriers

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 Effective Communication
• Communication skills are the performance of specific tasks and
behaviors such as:

• Obtaining a medical history

• Explaining a diagnosis and prognosis
• Giving therapeutic instructions
• Counseling

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Objective 1: Verbal communication
• Verbal communication is where people create noise to each other to
get across information.
Non-verbal communication
• A form of communication in which words are not used .
• It includes facial expressions, eye contact, tone of voice, body posture
and motions, and positioning within groups. It may also include the
way we wear our clothes or the silence we keep.
Categories of non-verbal communication
• Kinesics
• Paralinguistics
• Proxemics
• chronemics
kinesics
• Kinesics ( the language of body)
• Personal appearance
• Facial appearance
• Eye contact
• Movement
• Posture
• gesture
paralinguistics
• Quality
• Volume
• Pace
• Pitch
• Pronunciation
• pauses
proxemics
• Intimate space
• Personal space
• Social space
• Public space

• Chronemics
The language of time
 Objective 2: Types of
Relationships

• Professional / Therapeutic

• Social

• Intimate

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Objective 3: Therapeutic / Professional
Communication
• Flexibility

• Efficiency

• Therapeutic Maneuver is directed at: Giving Support –

Ventilation of Feelings – Effective limit setting
Therapeutic Nurse – Patient Relationship

• It is a professional relationship in which the nurse and patient joint

together for a defined period to achieve health –related treatment
goals

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 Goals of therapeutic relationships
• Supporting clients and families to understand their
personalized experience of an illness.
• Helping the clients and their families learn practical strategies
to effectively self management chronic health conditions.
• Providing emotional and informational support
• Assisting clients to cope in difficult health circumstances
• Empowering clients with the knowledge and tools they need.

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 Social Relationship
• Defined as a relationship that is primarily initiated for the
purpose of friendship, socialization, enjoyment, or
accomplishment of a task
• Mutual needs are met during social interaction e.g. sharing ideas,
feelings and experiences

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 Differences between Therapeutic
Therapeutic and Social
Social
Relationship
Goal directed and purposeful. Definite goals not usually
established.
Focus on patient needs not nurse's Set up for mutual need
need satisfaction for both participate
The nurse must develop specific There is no need for such skills
skills, which are used to help
patient work throughout his
problem
There is a commitment to work No commitment to remain with
with the patient until the problem the individual. There is freedom
has been worked through to leave uncomfortable situation
Time Limit No time limit

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 Phases of Therapeutic Relationship

• The Pre-Orientation / Pre-Interaction Phase

(Nurse)
• Orientation / Initiation Phase (Nurse and Patient)
• Working Phase (Nurse and Patient)
• Termination Phase (Nurse and Patient)

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 The Pre-Orientation / Pre-Interaction Phase
Before the nurse contact with patient the main tasks include:
• Beginning with initial assessment:
• Obtaining available information from chart, significant
others, health team members
• Developing professional goals.
• Creating the physical environment for initial interaction

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 Orientation / Initiation Phase
Formulate contract for intervention
• Encountering the patient – first meeting (Nurse enter interpersonal
relationship with patient ( stranger role)
• The development of a trusting relationship.
• Introduction is important.
• Next, ask the client “how would you prefer to be addressed "assure the client
that personal information will be treated as confidential.

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Clarifying the purpose of relationship:
• Identify health needs is an essential dimension of the nurse- patient relationship
• What information is needed, how it will be utilized how the client participate in the
treatment process and what the client can expect from the encounter
identifying Client needs:
• Therapeutic relationships should directly resolve around patient`s needs and
preferences.
Defining the problem:
• the nurse ask for specific details to bring the client`s needs into sharper focus
• ex. Could you describe for me what happened next?, tell me something about your
reaction to your problem?, how do you fell about---
Defining Goals:
• Ex , Stop smoking, Eat a healthy diet

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 Working Phase
Goal: Promote client change
 Developing active problem-solving solutions
 Implementing phase of nursing process
 Focus of self-direction and self management
 The client role as dependent, independent, based on the amount of responsibility the
client is willing or able to assume for his or her care
 Avoid taking more responsibility for actions than the client or situation require
 Provide patient with opportunity for independent functioning
 Assess the success of new behavior or solution to problem
 Promoting change &teaching new skills

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 Termination Phase
Evaluate goal attainment and ensure therapeutic closure

The patient should have been prepared for final stage during the beginning of
the relationship
 the termination phase in short term relationship includes discharge planning,
agency referrals, and arranging follow up appointments in the community .
The nurse and client evaluate the client`s response to treatment and explore
the meaning of the relationship and what goals have been achieved
Evaluate progress toward goal attainment
Discussing the client`s achievements ,how the client and nurse feel about
ending the relationship and plan are an important part of the termination
phase
Feelings about termination of the relationship are recognized and explored

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Group Activity
• In pair, students have to consider the many ways in which people
communicate non-verbally, identify their own preferences, and begin
to think about the importance of this concept when interacting with
others that may be different from them.
Any Question

?
Objectives
• By the end of this interactive discussion, you will be able to:
• 1 Define the verbal and nonverbal communication
• 2 List types of Relationships.
• 3 Define therapeutic/professional communication
• 4 Discuss therapeutic nurse patient relationship.
• 5 Differentiate phases of therapeutic relationship.
Key Learning Points
• The verbal communication.
• Nonverbal communication (Kinesics, Paralinguistics, Proxemics,
chronemics).
• Therapeutic Nurse – Patient Relationship
• Goals of therapeutic relationships
• Phases of Therapeutic Relationship