PSYCHIATRIC NURSING

THERAPEUTIC / NON THERAPEUTIC COMMUNICATION

Therapeutic Communication
1.

Using SILENCE Nursing Action : Sit Quietly, while attentive to the patient Listen attentively, while the patients talks without attempting to compete with him Remain silent until the patient calms down

Situation : Patient upset and crying uncontrollably Nurse Action : Remain silent until the patient can gain control over his or her feelings

2. ACCEPTING

Nursing Action : “ I will stay with you.” Nurse option : “It sounds as if you are both upset.”

3. GIVING RECOGNITION
NURSE:  “ I see that you have changed your dress and combed your hair before coming to breakfast.”
 

“ You have painted a picture.”

4. MAKING OBSERVATIONS
Nurse :  “ You seem very concerned about something this morning.”
 

“You seem quiet this evening.” “You are touching my knee with your hand.”

5. OFFERING SELF

Nurse : “I will stay with you for a while.” “Its time to go to your therapy, I will go with you.”

6. REFLECTING
Situation : Patient angry and demands his breakfast. The nurse had observed the patient eating that morning.  Nurse: “ You seem hungry. It has been several hours since you had breakfast. Come, let me give you some tea or milk.”

Situation : Patients states angrily that he or she is now the head nurse and everyone must follow his directions. Nurse : “ You seem angry when you talk about being a nurse.”

Patient : “ Who do you people think you are, forcing patients to work like this? How dare you? Nurse : “ You sound furious about your assignment.”

7. RESTATING
Patient : “ The aide slept all night long. I know because I watched him sleep.”  Nurse: “You seem to have difficulty sleeping at night.” Patient : “I’ve messed up my life, my job, and my love life. I’m just going to make a new beginning.”  Nurse : You’re saying that your experiences have been

8. GIVING INFORMATION
Nursing Action: SHORT, SIMPLE DIRECTIONS. BRIEF, CONCISE EXPLANATION.

Patient: “My arms don’t feel like a part of me. What could this strange feeling be caused by and when will it go away?” Nurse: “This strange feeling you have concerning your arms is a a part of your illness. It will go away as you become better.” Nurse: You seemed confused, I am your nurse, You are in the Metropolitan Psychiatric Institute.

9. PRESENTING REALITY
Patient: “I am hearing voices calling me filthy names.”  Nurse: “I don’t hear voices. You sound as if you are frightened.”  Patient: “I demand a trial. I cannot be executed without trial.”  Nurse: “You are not going to be executed. You seem frightened.”

10. REDIRECTING
Patient: “ Nurse, you look very tired.” Nurse: “ Yes, I am tired. We are busy discussing your feelings about the staff.”

NON THERAPEUTIC COMMUNICATION

REASSURING Patient : “Everyone here wants to see me dead.” Nurse : “ This is a hospital. The staff is here to help you and protect you from all harm.”

Patient : “ I see my Doctor everyday. How can you help me to get back my memory?”  Nurse : “I understand exactly what you are feeling. You’ll find our talks will help you.”  Patient : “I refuse to take those psychological exams, why should I take anyway?”  Nurse : “It will help you to get better and you will be able to go home sooner.”

2. GIVING APPROVAL
NURSE: “ Oh, you look beautiful. I like your new dress.” “ You have done a good job.”

3. REJECTING
Situation: The nurse/patient approach in 2 persons parallel another patient joins them, where shall the nurse sit?  Inappropriate action: The nurse sitting on the other side of the new patient  Nurse: “ I see that you are quite anxious and upset so I will leave you alone.”

4. DISAPPROVING

Nurse : Gently Inquire from the patient, “How could you say such a thing to me?”

5. AGREEING
Patient: “ You know that the President invited me to the White House,”  Nurse: “Have you decided to accept the invitation?”

6. DISAGREEING
Patient: “ The aide slept all night long. I watched her sleep.”  Nurse: “ That’s hard to believe, but I will look into it.”  Patient: “I hear voices calling me dirty names.”  Nurse: “ You only think that you hear voices. Its all in your imagination.

7. ADVISING
Nurse: “ I think it would be a good idea for you to go home on a weekend pass,” Nurse: “ Therapy is very nice. Why don’t you give it a try?”

8. PROBING
Nurse: “Why did you……….” Nurse: “ When did you……..”

9. GIVING INFORMATION

Inappropriate Action: Giving detailed, scientific explanation.

10. THREATENING  Nurse: “If you don’t eat, we will be forced to tube feed you.”

11. REINFORCING
Nurse: “Since you claim that your arm is paralyzed, and can’t dial the phone, I’ll call your wife for you.”  Nurse: “I know that you are afraid of having a heart attack, so I’ll listen to your heart and take your pulse frequently.”

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