Therapeutic communication and it's techniques

Therapeutic communication and techniques

1. Therapeutic communication NAMALOBA

2. Therapeutic communication has roots going back to Florence Nightingale, who insisted on the importance of building trusting relationships with patients She taught that therapeutic healing resulted from nurses’ presence with patients

3. Since then, several professional nursing associations have highlighted therapeutic communication as one of the most vital elements in nursing.  a type of professional communication defined as the purposeful, interpersonal, information-transmitting process that leads to client understanding and participation

4. Therapeutic communication is different from social interaction. Social interaction does not have a goal or purpose and includes casual sharing of information, whereas therapeutic communication has a goal or purpose

5. something that is therapeutic is done to help a person cope with a situation or heal and ultimately feel happier and more relaxed. The goals of therapeutic communication are to help a patient feel cared for and understood and establish a relationship in which the patient feels free to express any concerns

6. A nurse must have self-awareness and interpersonal skills to communicate therapeutically Effective use of communication will play an important role in your nursing career and personal life The art of therapeutic communication does not come naturally; it must be learned.

7. GOALS OF THERAPEUTIC COMMUNICATION. To establish a therapeutic nurse – patient relationship. • To identify client’s most important needs . • For assessing client’s perception and the problem.

8. To facilitate client’s expression of emotions or feelings. • Helps in problem solving. • Clarifies the area of conflict and anxiety. • To identify client’s strengths and weaknesses Areas where therapeutic communication is commonly used in nursing-;

9. In the nursing process Nurses use the nursing process for best outcome in patient care-. The process includes -; assessment Nursing diagnosis Planning Implementation evaluation

10. Assessment-;The nurse must be able to collect client data accurately by paying attention to both verbal and nonverbal cues and information Nursing dx - will be arrived at through good communication Planning - involves accurate communication among all members of the healthcare team, as well as with the client and the family

11. Implementation of the nursing care plan, the nurse communicates with the client and family and the entire healthcare team on the actions that will be implemented in the treatment. Ongoing evaluation of the effectiveness of nursing interventions depends on clear and coherent communication among all persons concerned.

12. Education Client teaching and preparation for discharge depend on accurate communication and client understanding Collaborating – works with all health care team members to achieve common goal Delegating- the nurse delegates duties to fellow or other staffs-must know what tasks are legal and appropriate to delegate

13. therapeutic communication techniques Therapeutic communication techniques are strategies to encourage clients to express their thoughts and feelings more effectively These techniques are tools for building and maintaining rapport with others. Some techniques are verbal; others are nonverbal

14. Listening Listening is an important part of communication. There are three main types of listening, including competitive, passive, and active listening. Competitive listening occurs when we are mostly focused on sharing our own point of view instead of listening to someone else. Passive listening occurs when we are not interested in listening to the other person, and we assume we understand

15. active listening interested in what the other person is saying while also actively verifying our understanding with them Nonverbal communication is an important component of active listening

16. PROCESS OFLISTENING It has 6 steps receiving Attending Interpreting Recalling Evaluating Responding

17. Purpose of listening It facilitates understanding between the nurse and the client. It helps to reach a common agreement about what concerns the client and how he/she is experiencing his/her concerns. It communicates interest in the importance of the client respect to the client

18. Touch Professional touch is a powerful way to communicate caring and empathy if done respectfully while also being aware of the client’s preferences, cultural beliefs, and personal boundaries. Nurses use professional touch when assessing, expressing concern, or comforting patients. For example, simply holding a patient’s hand during a painful procedure can effectively provide comfort.

19. For individuals with a history of trauma, touch can be negatively perceived, so it is important to ask permission before touching. Inform the person before engaging in medical procedures requiring touch such as, “I need to hold down your arm so I can draw blood.”

20. Empathy This is an intellectual process that involves the ability of the nurse to perceive correctly the clients feelings and to communicate the perception. It means temporarily living in the other person’s life, moving in it delicately without being judgmental

21. It is a continuous process where a nurse lays aside own concerns hence leaving own way of experiencing and perceiving reality preferring to sense and respond to experiences and perceptions of the client. This sensing may be intense and enduring with the nurses experiencing the clients’ thoughts, and feelings as if they had originated from him.

22. Purpose of empathy This enables the client to get company in their journey no matter how bumpy it may be Empathy encourages deeper and further exploration in the part of the client in the relationship.

23. It lays a foundation for the counseling responsibility of the nurse The understanding and acceptance helps the client to feel relieved as if an emotional block has been removed from their mind.

24. Genuineness/ Congruence The willingness to be real and not hiding behind a professional façade and to be reasonably rule free is called Genuineness. It’s maintaining consistency.

25. Genuineness is being honest with oneself and with the client Present oneself in a genuine and boundaried manner to foster a therapeutic relationship. Purpose of Genuineness It communicates high degree of harmony in communication

26. It facilitates stimulation of client’s authentic behavior The client is able to pour out their problems i.e. genuineness encourages clients self disclosure It establishment of a good relationship between the client and the nurse.

27. Unconditional Positive Regard Means being non-judgmental. UPR introduces new possibilities of self acceptance in a client who may be overwhelmed by emotions such as anger, hurt, guilt and fear.

28. Purpose of UPR It sabotages the condition the client has lived with (by living according to the expectations of significant other. This is referred to as counter conditioning. It frees the client from their defensive posturing and enables them to trust and feel safe enough to explore the feared material in their unconscious. Helps clients to become more accepting to themselves

29. Paraphrasing It means restarting the content of what the client has said. It mirrors the literal meaning of communication. Culley (1997) adds that paraphrasing is what the nurse understands to be the core message of the client’s communication. Purpose It enables the client to elaborate the key ideas or thoughts

30. To check the nurses’ perception of what the client has said. To communicate core qualities of acceptance & understanding to build a trusting relationship. It helps clients to focus on a particular situation and enables them to keep track with repeating the story. It helps the client make a decision because by repeating key words and phrases, the essence of the problem is clarified.

31. Reflection of feelings. This is the ability of the nurse to pick out the feelings and emotions expressed by the client and to communicate back   Purpose The client is helped to deal with emotional overload. The client feels understood and taken care of It enables the clients to discriminate accuracy among various feelings. It encourages clients to express more of their feelings about a particular situation, person or whatever.

32. Summarization This is the process of bring ing together all that has been talked about during part of or the whole session. It attempts to draw together the main threads that have been discussed. It clarifies what has been accomplished and still needs to be done ( Sulton & Stewart 1997).

33. Purpose To outline relevant facts, feelings and meanings To promote further exploration of a particular theme To close discussion on a particular theme Enables the nurse and the client to find a direction Ends a session.  

34. Minimal prompts This is the art of encouraging people to talk about their problem situations. It involves nodding, smile, a gesture of hand or using words like then, sure, exactly, go on,, alright , I see etc.  

35. Purpose Shows or demonstrates concern Provides support Communicates acceptance Encourages client to talk. Helps clients to explore issues fully Through encouragement the nurse helps client to overcome his negative feelings

36. Concreteness Being concrete means being able to get clients to be specific in what they are saying. It is the quality of being clear and not vague or abstract

37. Purpose It challenges the client to provide accurate information which reduces ambiguity. It brings the person in a more direct contact with themselves. It provides an opportunity for self change.

38. There will be mutual understanding between nurse and the client and hence the therapeutic value of the sessions will be achieved. Helps the nurse to understand exactly where the client is and why he feels the way he does

39. Immediacy . It is also referred to as ‘here & now’ or ‘you me talk’. It is putting into words what is happening by pointing out the distortion games and discrepancies which are going on in the room.  

40. Purpose It addresses lack of direction by enabling the nurse and the client see what is going on. It helps the other look at the interaction with the relation as it is happening. It makes it possible for both client and the nurse to see clearly what is going on between them

41. The client may learn that it is possible to confront, reveal himself and express freely his negative and positive feelings to another person in interpersonal relationships Client dares to face the reality of himself and others since now he can use words that convey directly what he wants to say rather than using ambiguous words and twisted meaning

42. Self disclosure. This is the process by which we let ourselves be known to others and in the process we enhance our self awareness. It involves sharing with client a similar experience for the one that is causing the client present difficulties. It should be appropriately given.  

43. Its content is a). If it keeps the client to target and doesn’t destruct b). If it does not add to the clients burden. c). If it is not overdone/too often.

44. Purpose To show genuineness in helping To share emotions The self is used as a model Provides more options to problem solving. It improves usefulness in problem solving.

45. Silence Is the state of being there for the client. It’s a way of giving clients space and encouragement to get more deeply in touch with their thoughts and feelings. There are times when both the nurse and the client will remain silent to reflect on what is happening.  

46. Purpose Encourages client to talk. Helps clients to come in touch with their feelings & thoughts. It gives the client time to organize his ideas The client may need time alone to pull their feelings together before they explore further Gives client the opportunity to think or reflect  

47. Questioning This is the ability of the nurse to get more information or seek clarification from the client using open ended questions. Open ended questions encourage clients to talk about themselves. Closed ended questions are however to be avoided because they make a client defensive and sometimes feel judged. Questioning is a tool for determining whether a client’s problem is physical or psychological.  

48. Purpose Enables the nurse understand their client better. Helps identify the issues that the client is stuck with. Open ended questions help client talk more freely and openly

49. It allows client to choose the approach he wishes to take in dealing with the question. Probes help the client to explore issues fully Questions enable the client understand their internal view point.

50. NB/. A nurse should not ask questions for their own curiosity or questions that put answers in client’s mouths, questions that require Yes/No answer. A nurse should also avoid seeking information when the client is least in control e.g. when the client is crying.

51. Focusing This is the ability of a nurse to be firm in helping the client work on the most pressing issues at a time.  Purpose It provides direction Helps to bring clarity by prioritizing It helps clients to focus on important issues that they might otherwise avoid Often when scattered elements are brought together, the client sees the bigger picture more clearly.

52. Confrontation This is the art of challenging discrepancies in the clients verbal and non-verbal messages caringly hence inviting the client to examine themselves. Wrong attitude and resistance must be confronted e.g. a client may be experiencing happiness on the face while talking about painful experiences  

53. Purpose It challenges the client to provide accurate information which reduces ambiguity. It brings the person in a more direct contact with themselves. It provides an opportunity for self challenges Steers the client from diverting from the main issue Helps clients understand how faulty or distorted they are

54. Attending / Appropriate sitting position   Attending refers to the nurse being present for the client physically, psychologically and even emotionally. Attending means being there ready to listen to the client’s issue. The skill of attending can be non-verbally manifested by the nurse in the following acronym  

55. SOLER. S - Sit squarely facing the client . I.e. adopt a posture that indicates involvement. This posture says, ‘I am here with you; I am available to you’. Turning your body away from another person while you talk to him or her can lessen your degree of contact with that person. O - Open posture avoiding closed arms. How we sit either with crossed hands or legs can communicate the discomfort we may have with them. L - Leaning forward at appropriate moments. This communicates that you are attentive .

56. E - Eye contact but do not stare at the client. This shows that you are listening to the client and you are interested in them. R - Relax .nurse / Counselors should maintain a relaxed posture even as they sit with clients.  

57. Purpose Makes the client feel accepted and wanted. Enables the nurse to note denial & confusion

58. Observation Observation This is the ability of the nurse to see, pick and note the behavior of the client from both physical nonverbal messages and verbal messages.  

59. Purpose It helps the nurse identify the energy levels of the client by observing the movement of the hands, the feet and even the head. It enables the nurse to understand the genuineness of what the client may be saying e.g. if a client has been well groomed initially and suddenly comes with a general un-kept appearance, it indicates some changes in his/her approach in life.

60. The emotions of a client give a clear guide on the theory and techniques to apply on a particular client. To gather first hand non-verbal data about the client in order to understand how he feels.

61. NB/ Expression such as smile, frowning, raised eye brows, and twisted lips; locked arms and body postures movement and gestures should be observed. On voice observe the tone, the pitch and spacing of words

62. Advanced level of empathy It is the ability to discern and understand the deeper meanings in what clients are exploring Purpose To help clients see their problems and concerns more clearly and in a context that will enable them move forward

63. help clients take fuller ownership of partially owned experiences, behaviors and feelings rather from describing the problem as though he were the victim Help clients draw logical conclusion from what they are saying help clients to see what they may be overlooking