Therapeutic communication

Therapeutic communication and it's techniques

1. THERAPEUTIC COMMUNICATION AND INTERPERSONAL RELATIONSHIP Unit 5

2. Review communication process factors affecting communication INTRO: communication refers to the reciprocal exchange of information, ideas, belief feelings and attitudes between persons communication is very significant in nursing. Def : the nurse directs the communication towards the patient to identify his current health problems, plans implements and evaluates the action taken.

3. Goal of nurse pt comm. Self –Realization, self acceptance and an increased genuine self-respect. A clear sense of personal identify and an improved level of personal integration. An ability to form intimate interdependent, interpersonal relationship with a capacity to give and receive love.

4. Function of a nurse in therapeutic nurse pt interaction Allows the pt to express his thoughts and feelings and relates these to observed and reported interactions. Clarifies the areas of conflict and anxiety. Identify the maximizes the patients ego strengths and encourages socialization and family relatedness. Corrects and communication problems. Modifies adaptive behavior patterns.

5. purpose Environmental changes from home to hospital : they desire protection, comfort rest, and freedom from demands of their usual home and work environments. Nurturance: they wish someone to care for them, cure their illness and make them feel better. Control: they are aware of their destructive impulses to themselves or others but lack internal control.

6. Cont.. 4. Psychiatric symptoms: they describe symptoms of depression nervousness or crying spells. They knew they need psychiatric help and actively want to help themselves. 5. The nurse help the pt to cope with the present problems. 6. The nurse assists the patient to identify emerging problems realistically. 7. The nurse help the pt to try out new alternative for his or her problems. 8. The nurse help the pt to understand the problems.

7. types Verbal communication: it involves the spoken word. It is an exchange using the elements of language. Taken alone verbal communication.

8. Non verbal Includes everything that doen’t involve the spoken or wirtten words, including all of the five senses, it is often uncounsciously motivated and may more accurately indicates the person’s meaning than the words being spoken.

9. Types of non verbal behaviours Vocal cues or paralinguistic cues Action cues Object cues touch

10. Meta communication It is an implicit but integral part of the message and is an interpersonal bridge between verbal and nonverbal components communication. How the message should uinderstand by the receiver. E.g the message ‘’you look fresh&lovely today’’ is conveyed with wrinkles of the fore head.

11. Elements of communication 1 . Sender-the sender : it is the orginator of the message. To be an effective communicator he must know his objectively clearly defined his audience it interest and needs, his message, channels of communication, his professional ability and ties abd limitations.

12. Cont.. 2. Receiver : the receiver is the target of the communiocation and must be able to understand or decode the message. This can be a single person or a group.

13. Cont.. 3. message: a message is the information which the communicator transmits to the receiver, to receive, understand ,accept and act upon. It may be in the form of words, pictures, or signs. A good message must be. Meaningful,accurate clear understands timely and adequate fitting the audience, intersting.

14. 4. channels of com; interpersonal comm-face to face communication Mass media- TV, radio printed media, phamplets Folk media-traditional folk media folkdance singing, dramas.

15. Therapeutic communication According to berlo, under 4 headings as the SMCR model S- is source M- stands for message C- channel R- receiver

16. Characteristics of therapeutic communication 1. Response dimension Genuiness Respect Emapthtic understanding Concretness 2.Action dimension Confrontation,immediacy,nurse self disclosure, catharsis, role play

17. Ethics and responsibilities A moral principle exists that involve a moral obligations or duty to do or to refrain from doing something that is within the power of the person to do or is such that the person can do other wise. Some source of responsibility is involved as well as a source or reward, praise, or punishment ro responsible actions The cause of the behaviour is internal to the individual and he or she is not complelled to act by others.

18. Com.with individuals and in groups Non verbal com. With individuals: Body language is a form of nonverbal communication, consisting of body pose, gestures, eye movements and paraliuistic cues e.x tone of voice and rate of speech humans send and interpret such signals unconsciously. Human com. Consists of 93% body language and paralinguistic cues while only 7% of com. Consists of words themselves.

19. Physical expression Like waving pointing touching and slouging are all forms of nonverbal communication. The study of body movmeent and expression is known as kinesics. Human move their bodies when communicating because as research as shown it helps ease the mental effort when communication is difficult. Ex , hands of knees indicates readiness Hands on hips impatience Lock your hands behind your back self control Locked hands behind head states confidence.

20. Body language and space Interpersonal space refers to the psychological bubble that we can imagine exists when someone is standing way too close to us. Research has revealed tht in north america there are four different zones of interpersonal space. the first zone is called intimate distance and ranges from touching to about eigtheen itches apart. Intimate distance is the space around us that we reserve for lovers children as well as close family members and friends. the second zone is called personal distance and begins about an arm’s length away starting around eighteen inches from our person and ending aout four feet away.

21. Language difficulties Misunderstandings in communication are common because of the many different ways people use language. Though there is no right or wrong way to communicate, avoiding language barriers such as jargon, bypassing and offensive language may prevent misunderstnadings in group or interpersonal discussions.

22. Therapeutic communication techniques Listening is an active process of receiving information and examing reaction to the messages reveived. It is not simply hearing. It is essential to reach any understanding of the patient. It is the first rule of therapeutic-nurse relationship.active listening involve all the nurse’s senses. Ex maintaining eye contact

23. Cont.. Broad openings: here the nurse is encouraging the patient to select topics for discussion. Patient should be welcomed to the communication with warmth and resopect. Open-ended questions result in fuller more revealing answers. Ex what are u thinking about? can u tell me more about that?

24. Cont.. Questioning: the nurse skillfully asks open- ended questions during the intial admission. Interviewing skills are necessary to avoid asking too many personal questions in one session. Questions should be to active relevance and depth questions. How come u stopped taking ur medication ?

25. Cont.. Restating: nurse is repeat of the main thought the patient has expressed. It also indicates that the nurse is listening validating, reinforcing or calling attention to what has been said. Ex your mother left you when you were 5 year old?

26. Reflection: nurse is directing back the patients ideas, feeling questions or content. Reflection lets the patients know that the nurse has heard what was said and understand the content. it signifies understanding empathy interest and respect for the patient other techniques may not represent empathetic understanding You are looking sad and tense.

27. Focusing : helps the patient expand to a topic of importance and also helps in analyzing in detail. It helps the patient talk about life experiences or problem areas and accepts the responsibility for improving them. If the goal is to change thoughts feelings or belief the patinet must first identify and down them. I think u should talk more about ur relationship with ur husband?

28. Sharing perceptions: it involves asking the patient to verify the nurse’s understanding of what the patient is thinking or feeling. Ex: nurse is interviewing an alcoholic patient Patient: my wife and children are so good. They love me but I do not know what happended to me I can’t care them I can’t stop drinking. Nurse: you seem to be very disappointed with your drinking am right about that?

29. Theme identification: are underlying issues or problems experienced by the patient that emerge repeatedly during the course of the nurse patient relationship like anxiety depression It sounds like that is very improtant to you. You have mentioned it a very few times.

30. Silence: the nurse use lack of verbal communication for a therapeutic reason. It allows the optient to think and gain insights. Silence on the part of nurse has verying effects depending on how the aptient perceives it. To a vocal patient silence on the part of nurse may be welcome but with a depressed or withdrawn patient the nurse silence may convey suport understanding and aceptance.

31. Humour : is basic part of our personality and has a place in theapeutic nurse-patient relationship . It is the discharge of energy through the comedian enjoyment of imperfect. If may be helpful with a patient experincing mild to moderate anxiety humour should be consistent with social and cultural values.

32. Informing: or giving information is nurse shares simple facts with the patient. This skill is use in patient education .like when to take medication, necessary precautions and side effects. Think you need to know more about your medication works informing should not fall in to giving advice.

33. Suggesting: is the presentation of alternate ideas as a theapeutic technique it is useful intervention in the working phase of the relationship. Suggesting or giving advice can be non-therapeutic. Patient may take nurse advice and have an unsucceessful outcome, the patient reurns to blame nurse.

34. Confrontation: involves anger amnd aggression. The therapeutic dimension is assertiveness rather than aggression. Confrontation is an attempt by the nurse to make the patient aware of incongruence in is or her feelings, attuitudes, beliefs and behaviours. It may also help in discovery of ambivalent feelings in the patient. the nurse must be ready to work with the patient through the crisis after confrontating the patient. With out thuis commitiment the confrontation lack therapeutic potential and may damage nurse patient relationship

35. Role playing : involes acting out a particular situation. It increases patients insight in to human relations can deep the ability to see the situation from another persons point of view. Roleplaying can be used for attitude change and to promote self-awareness.

36. Touch therapy Touch is a powerful communication tool. It can elicit both negative and positive reactions, depending on the people involved and the circumstances of the interaction. it is a very basic and primitive form of communication and the appropriateness of its use is culturally determined. State of mind is vital for any person who is thinking about getting therapeutic touch or TT treatments.

37. Categories of touch Functional- professional Social-polite Friendship-warmth Love-intimacy Sexual-arousal

38. Therapy The therapist uses a light touch or holds his/her hands above the body; the client is usually seated in a massage. the therapist uses mediation to identify the energy field around a patients body and then to center and strengthen the connection to the patients energy field using their hands. The therapist does this by scanning the body from head to toe. Their hands are typically held in a horizontal position, side by side with their thumbs touching and their palms facing the patient in a butterfuly-like shadow.

39. Benefit A sensation of enveloping warmth from the therapist’s touch A totally relaxed state The feeling of vibrations of energy coursing through the entire body Intense euphoruia and feelings of peace A kaleidoscope of color and beautiful light An intense sense of clairty, inner peace and well-being.

40. Barrier of communication with specific reference to psychopathology Language :the most important communication barrier is language. Many clients speak english as a second language and a smaller proportion are hearing imparied or deaf. These groups present nursing withn the greatest challenge. Avilable tp translate important information.

41. Cultural considerations Specific cultural considerations can provide important insight into effective communication. expolitical religious or thnic presecution or to obtain better economic or educational opportunities indiviudals have left their countries of origin. Different cultures use language differently. Ex medical personnel havea jargon or their own Clients may not understand PET scan or boderline.

42. Age and development level Age differences may pose communication problems. With aging can come loss of hearing eyesight, or cognition. In addition the elderly hold values that may be different than those of younger people. Children do not think abstractly and reaching their level of understanding reqwuires a more concrete apporach .

43. Level of health An individual with depression may speak little because of the level of illness, and initiating and maintaining communication may be difficult. Those with mania may have unusual speech patterns, so the nurse may need to set limits. The client who has paranoia may be suspicious and difficult to bond with, whereas clients who are delirious need simple, short sentences repeated to them to communicate .

44. Knowledge level Communication is affected by the amount and kinds of facts the client has at hand. The nurse assesses the clients fund of knowledge and educational background at the time of admission. The knowledge level will dictate both teaching needs and the method of instruction. The nurse also speaks in words that are commensurate with the clients level of understanding.

45. Time Counseling takes time, and the need to hurry blocks communication. Therefore, plan to interview when neither you nor the patient is pressured. Hectic times to avoid include changes of shift, visitations, doctors rounds or when other appointments are pending.

46. Day dreaming or self talk People speak at a rate of 125 to 150 words a minute. However they have he ability to listen to 800 words per minute. Therefore as the client talk, the nurses mind may wander. Be sure to constantly attend to what the client says, to control personal thoughts and to stay alert.

47. The nurses or clients feelings Whenever the nurse or client becomes anxious communication changes. Talking about or listening to disturbing experiences or information is uncomfortable.

48. Unhelpful communication techniques Nurses overcome responses that halt communication by being aware of the approach. Most of these responses consist of statements the change the focus. Finalize the interview or result in the clients feeling inadequate threatened or confused.

49. Therapeutic attitudes General attitude toward the mentallt ill The community responds to the mentally ill through denial, isoration and rejection. These are also alack of understanding of mental illness as any other illness, and a lack of trendency to reject both the patients and those who treat them. Mentally ill are viewed as people with mnop capacity for understanding People feel mental illness cannot be cured, and even if the patient gets better, complete physical rest is considered essential. The mentally ill are by and large perceived as aggressive violent and dangerous.

50. Cont.. An individuals values and personal beliefs affect his attidude about mental illness, the mentally ill and treatment of mental ilness. There still exists a stigma surrounding individual who need or use psychiatric mental health services. The need continues for public education to modify or alter muisconceptions about mental illness and people with mental disorders.

51. Dynamic of therapeutic nurse patient relationship Introduction: nurse patient relationship is significant psychiatric nursing too. The objective of psychiatric nursing is- the promotion for mental health, prevention of mental illness and care and rehabilitation of the patient with mental illness.

52. Types of relationship Social relationship: it is just happens with mutual interests for satisfying needs of each other. Intimate relationship it is a relationship between two individuals committed to one another, caring for and respecting each other partner type.

53. Therapeutic relationship Definition: one to one relationships is the end result of a series of planned purpose interaction between two human being, a nurse and a patient.

54. purposes It is a therapeutic goal directed relationship between the nurse and the patient. To bring insight and behavioural changes. To develop mutual growth between two indiviudals. To promote self realization, self acceptance and an inceased genuine self respect self identify and personal integration. It is the central medicine through which all psychiatric care is provided to care the mental illness.

55. Cont.. To identify appropriate nursing approaches. to achieve developmental goals Provide comfort, protection rest and freedom from demands of thire unual home and work envidonment To nurture the clients illness Nurse assist the client identify present problems realistically and tryout new patterns of behaviour.

56. principles Treat the client as an indivdual Accept the client as he is Aware the total needs of the client Nurse understands herself and clients needs motives desires, feelings and tears. Emotional and involvemtn is essential Objectivity has to be manintained Consistency in behaviour Set approximate limits and goals Honest and open communication his needed. Engage in active listening

57. Therapeutic use of self gaining self awareness Self awareness: it is our important which a nurse must identify herself himself. Self awareness includes self-concept, beliefs and values and life experiences. Belief and values with which a nurse comes will affect the way she takes care of her patient or develop IPR. If she values the human life and believes in respecting the person as a human being she will give individualized care to the patient.

58. Campbell 1980 has identified a holistic nursing model of self awareness 1.Psychological: includes knowledge of emotions, motivations, self concept and personality. Being psychologically self-aware means being sensitive to feelings and outside events that affect those feelings.

59. Cont.. 2.physilogical includes the knowledge of personal and general physiology, as well as bodily image and physical potential. 3.environmental : consists of social-cultural environment relationships with ithers and knowledge of the relationship between huma and nature.

60. Cont.. 4. philosophical: it includes sense of life having meaning together these components provide a model that can be used to promote the self-awareness and self growth of nurses and for patient for whom they care.

61. Attitude towards the patient Attitudes the nurse has developed over the course of a lifetime may determine the nurse’s behavior towards the client. Rapport it is defined as a relationship of mental sympathy and understanding especially between patient and therapist the essential qualities for developing rapport are warmth, genuineness, and empathizing ability.

62. Johari window The johari window is a model that is used to describe human interaction. It is named after the first names of its inventors Joseph luft and harry Ingham.

63. Johari window OPEN BLIND HIDDEN Not known to others UNKNOWN Known to others

64. First quadrant is the open area which consists of information that is open to the public and easy for one to reveal. The first pane, the arena contains things that I know about myself and about which the group knows. Characterized by free and open exchanges of information between myself and others this behavior is public and available to everyone.

65. The next box is the blind area also recognized as things others know about us but we don’t’ know about ourselves. The second pane, the blind spot contains information that I do not know about myself but of which the group may know. As I begin to participate in the group, I am not aware of the information I communicate to the group. The people in the group learn this information from my verbal cues, mannerisms the way I say things or the style in which I relate to others

66. The third quadrant is the hidden area is more personal information that we know about ourselves, but we chose not to share this information with others. Pane three the ‘’facade or hidden area. Contains information that I know about myself but the group does not know. I keep these things hidden from them. I may fear that if the group knew my feelings, perceptions and opinions about the group or the individuals in the group, they might reject attack, or hurt me.

67. The final and fourth quadrant is the unknown area that is information that you and no one else has yet to discovery about yourself. The johari window can allow for one to have eye opening experiences about themselves. The fourth and lat pane, the unknown contains things that neither I nor the group knows about me. I may never become aware of material buried far below the surface in my learn other material. Though, through a feedback exchange among us.

68. Therapeutic nurse-patient relationship its phase conditions essential to development of a therapeutic relations A vital characteristic of nurse patient relationship is the sharing of behaviors, thoughts and feelings. ( Peplau ) 1962 The task of the relationship have been categorized into 4 phases: The Pre interaction phase The orientation The working phase The termination phase

69. The pre interaction phase Begins before the nurse’s first contact with the patient. Here preparation for the first encounter with the client. It begins before the nurse’s first contact with the patient. A common fear of nurse related to the stereotype of psychiatric patient as violent. Other fear is related to nurses questioning their own mental health status. Nurses may fear mental illness and worry that exposure to psychiatric patients might cause them to lose their own needs.

70. task Obtaining available information from case sheet, chart, significant others, and other health team members. Initial assessment is begun Prepare self for working activity

71. The orientation phase The introductory contract between client and nurse first meet. It is the introductory phase that the nurse and patient first meet. One of the nurses concerns is to find out why the patient sought help and whether it was voluntary.

72. elements Name of the individual Roles of nurse and patient Responsibilities of nurse and patient Expectations of nurse and patient Purpose of the relationship Meeting location and time Conditions for termination confidentiality

73. Working phase Most of the therapeutic work is carried out during the working phase. The nurse helps the patient to master anxieties increase independence and self-responsibility and develops constructive coping mechanisms. Actual behavior change is the focus of this phase.

74. task Maintaining the trust and rapport Promoting the clients insight and perception of reality Develop realistic self concepts and promote self confidence. Develop a plan of action implement the plan and evaluate the results of the plan. Help client to change her/him dysfunctional behavior.