Therapeutic Commmunication-Unit 4(1).pptx

The Therapeutic interaction between the nurse and the patient helps to develop mutual growth of two individuals and the world of each is enlarged and enriched by the other.

The two communicate through a dialogue or discussion, not a monologue.
Therefore the therapeutic nurse-patient interaction is a mutual learning experience and a corrective emotional experience for the patient.

In this relationship, the nurse uses personal attributes and clinical techniques in working with the patient to bring about insight and behavioral change.

1. COURSE - B.Sc Nursing SUBJECT - Mental Health Nursing UNIT- IV -Therapeutic Communication and Nurse – patient Relationship TOPIC - Therapeutic Communication PREPARED BY – Mr. Vethadhas P, M.Sc. (N), Assistant Professor.

2. CENTRAL OBJECTIVES Helps the students to understand and acquire knowledge about the therapeutic communication and to develop desirable attitude and skills in applying this knowledge in hospital and day to day practice.

3. SPECIFIC OBJECTI VES At the end of the class student will be able to state about the therapeutic communication define therapeutic communication enumerates the goals of therapeutic communication describe the characteristics of therapeutic communication enlist the types of therapeutic communication explain about the therapeutic communication techniques discuss the types of relationship

4. INTRODUCTION THERAPEUTIC COMMUNICATION: The Therapeutic interaction between the nurse and the patient helps to develop mutual growth of two individuals and the world of each is enlarged and enriched by the other. The two communicate through a dialogue or discussion, not a monologue.

5. CONT.., Therefore the therapeutic nurse-patient interaction is a mutual learning experience and a corrective emotional experience for the patient. In this relationship, the nurse uses personal attributes and clinical techniques in working with the patient to bring about insight and behavioral change.

6. DEFINITION “It is an interpersonal interaction between the nurse and the patient during which the nurse focuses on the patient’s specific needs to promote an effective exchange of information.”

7. GOALS OF THERAPEUTIC COMMUNICATION Establish a therapeutic nurse- patient relationship. Identify the most important patient’s needs. Assess the patient’s perception of the problem. Facilitate the patient’s expression of emotions. Implement interventions designed to address the patient’s needs.

8. CHARACTERISTICS OF THERAPEUTIC COMMUNICATION The patient should be the primary focus of interaction. A professional attitude sets the tone of the therapeutic relationship. Use self- disclosure cautiously and only when it has a therapeutic purpose. Avoid social relationship with patients. Maintain patient confidentiality.

9. CONT.., Assess the patient’s intellectual competence to determine the level of understanding. Implement interventions from a theoretic base. Maintain a non- judgmental attitude. Avoid making judgments about patient’s behavior. Avoid giving advice. Guide the patient to reinterpret his or her experiences rationally.

10. TYPES OF THERAPEUTIC COMMUNICATION I ) VERBAL COMMUNICATION: It occurs through the medium of words- spoken, or written. It can convey factual information accurately and efficiently.

11. CONT.., II ) NON – VERBAL COMMUNICATION : It includes everything that does not involve the spoken or written word. It involves all five senses. There are five types of non – verbal behavior. Vocal Action Object Space Touch

12. CONT.., 1. Vocal Cues Are also known as Paralinguistic cues . They include all the noises and extra speech sounds . EXAMPLE - Tone of voice, pitch, Sounds such as Laughing, nervous coughing.

13. CONT.., 2. Action Cues Are mainly body movements. They include posture, Facial expression , mannerisms, actions etc. Facial movements and postures particularly significant in interpreting the speaker’s mood 3. Object Cues Are dress, furnishings and possessions. They communicate something to the observer about the speaker’s feelings.

14. CONT.., 4. Space Provides another cue to the nature of the relationship between two people . Example- Chairs placed in a circle decrease the space between the patient’s and between the nurse and the patients.

15. CONT.., 5.Touch Is the most personal of the non- verbal messages . It involves both personal space and action . Most often in nursing, we use touch with therapeutic goal . We lay hands on the body of an ill person for the purpose of comforting him/her .

16. THERAPEUTIC COMMUNICATION TECHNIQUES 1. LISTENING : It is an active process of receiving information. Observing and listening skills. Therapeutic value :Non-verbally communicates to the patient the nurse's interest and acceptance.

17. CONT.., 2. BROAD OPENINGS : Encouraging the client to select topics for discussion. Eg : What are you thinking about ? Therapeutic value: Indicates acceptance by the nurse and the value of patient's initiative.

18. CONT.., 3. RESTATING : Repeating the main thought expressed by the client . Eg : You say that your Mother left you when you were 5 years old. Therapeutic value: Indicates that the nurse is listening and validates, reinforces or calls attention to something important that has been said.

19. CONT.., 4. CLARIFICATION : Attempting to put unclear thoughts of the client into words to enhance nurse’s understanding or asking the client to explain what he/she means. Eg: “I am not sure about what you mean; could you tell me again” ? Therapeutic value: It helps to clarify feelings, ideas and perceptions of the patient and provides an explicit correlation between them and the patient's actions.

20. CONT.., 5. REFLECTION : Directing back the client’s ideas, feelings, questions and content. Eg : You are feeling anxious and tense and it is related to a conversation you had with your husband last night? Therapeutic value: Validates the nurse's understanding of what the patient is saying and signifies empathy, interest and respect for the patient.

21. CONT.., 6. HUMOR : The discharge of energy through the comic enjoyment of the imperfect. That gives a whole new meaning to the word ‘nervous’ , said with shared kidding between nurse and the patient. Therapeutic value: Can promote insight by making repressed material conscious, resolving paradoxes, tempering aggression and revealing new options, and is a socially acceptable form of sublimatio n.

22. CONT.., 7. INFORMING : The skill of information sharing. Eg: “I think you need to know more about your medications . ” Therapeutic value: Helpful in health teaching or patient education about relevant aspects of patient's well-being and self-care

23. CONT.., FOCUSING : Questions or statements that help the patient expand on a topic of importance. Eg : “I think we should talk more about your relationship with your Father”. Therapeutic value: Allows the patient to discuss central issues and keeps the communication process goal-directe d.

24. CONT.., 9. SHARING PERCEPTIONS : Asking the client to verify nurse’s understanding of what the client is thinking or feeling. Eg: “You are smiling, but I sense that you are really very angry with me.” Therapeutic value: Conveys the nurse's understanding to the patient and has the potential for clearing up confusing communication

25. CONT.., 10. THEME IDENTIFICATION : This involves identification of underlying issue or problems experienced by the client that emerge repeatedly during the course of the nurse-client relationship . Eg : “I noticed that you said, you have been hurt or rejected by the man. Do you think this is an underlying issue?” Therapeutic value: It allows the nurse to promote the patient's exploration and understanding of important problems.

26. CONT.., SILENCE: Lack of communication for a therapeutic reason. Eg : Sitting with a client and non-verbally communicating interest and involvement . Therapeutic value: Allows the patient time to think and gain insight, slows the pace of the interaction and encourages the patient to initiate conversation while enjoying the nurse's support, understanding and acceptance.

27. CONT.., SUGGESTING : Presentation of alternative ideas for the patient's consideration relative to problem solving. For example, "Have you thought about responding to your boss in a different way when he raises that issue with you? You could ask him if a specific problem has occurred.“ Therapeutic value: Increases the patient's perceived notions or choices.

28. TYPES OF RELATIONSHIP SOCIAL RELATIONSHIP : A social relationship can be defined as a relationship that is primarily initiated with the purpose of friendship, socialization, enjoyment or accomplishing a task. Mutual needs are met during social interaction. For example, participants share ideas, feelings and experiences.

29. CONT.., INTIMATE RELATIONSHIPS : An intimate relationship occurs between two individuals who have an emotional commitment to each other. Those in an intimate relationship usually react naturally with each other. Often the relationship is a partnership wherein each member cares about the other's need for growth and satisfaction.

30. CONT.., THERAPEUTIC RELATIONSHIPS : The therapeutic relationship between nurse and client differs from both a social and an intimate relationship in that the nurse maximizes inner communication skills, understanding of human behavior and personal strengths, in order to enhance the client's growth. The focus of the relationship is on the client's ideas, experiences and feelings.

31. SUMMARY So far we have discussed about the therapeutic communication, goals and Characteristics of therapeutic communication, types of therapeutic communication, techniques and types of relationship.

32. REFERENCES Sreevani.R, “A GUIDE TO MENTAL HEALTH AND PSYCHIATRIC NURSING”, ,(3 rd edition) ,Jaypee publication. Kumari.L, ”MENTAL HEALTH AND PSYCHIATRIC NURSING”, ,VMG Book House, Bangalore. Neeraja.K.P , “ ESSENTIAL OF MENTAL HEALTH AND PSYCHIATRIC NURSING”, ,(volume-I), Jaypee Publication.