Therapeutic communication and nurse - patient relationship

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1. Therapeutic Communication, Therapeutic N urse P atient Relationship

2. OBJECTIVES Define therapeutic communication Explain elements of commication Describe the therapeutic and non therapeutic verbal communication techniques. Identify the factors affecting communication. Discuss therapeutic touch. Describe active listening

3. Therapeutic Communication Is an interpersonal interaction between the nurse and the patient during which the nurse focuses on the patient’s specific need to promote an effective exchange of information. Therapeutic use of self is the ability to use one’s personality consciously and in full awareness in an attempt to establish relatedness and to structure nursing interventions.

4. Elements of communication process

5. Elements: Sender - prepare or creates messages Receiver - who gets the messages Message – the content of communication Feedback - response to the received message

6. Types of communication Verbal communication – words Non verbal Communication Vocal cues or Paralanguage Eye Behavior physical appearance and dress Body movement and posture Touch F acial expression

7. Factors Affecting Communication Values Attitudes Beliefs Perceptions Culture or Religion Social Status Gender Age or developmental level Environment

8. Goals Of Therapeutic Communication Establish a therapeutic nurse patient relationship Identify the most important patient needs Assess the patient’s perception of problem Facilitate the patient’s expression of emotion Implement interventions designed to address the patient’s needs .

9. Principles of therapeutic communication 1.The patient should be the primary focus 2. A professional attitude sets the tone of therapeutic relationship 3.Use self disclosure only when it has therapeutic purpose 4. Avoid social relationship with patients 5. Maintain confidentiality 6. Maintain non judgmental attitude 7. Assess patient intellectual competence 8. Avoid giving advice

10. Therapeutic Communication Techniques : There are two requirements for therapeutic communication: All communication must preserve the self-respect of both individuals. One should understand communication before giving any suggestions or advice .

11. 1. Listening: It is an active process of receiving information . Responses on the part of the nurse such as maintaining eye-to-eye contact, nodding, gesturing and other forms of receptive nonverbal communication convey to the patient that she is listened.

12. LISTENING TO THE PATIENT To listen actively is to be attentive to what client is saying, both verbally and nonverbally. Several nonverbal behaviors have been designed to facilitate attentive listening. S – Sit squarely facing the client. O – Observe an open posture. L – Lean forward toward the client. E – Establish eye contact. R – Relax.

13. 2. Broad Openings: Encouraging patients to select topics for discussion. Broad opening questions, such as "What are you thinking about?“ "Can you tell me more about that?" and "What shall we discuss today?" encourage the patient to select topics to discuss.

14. 3. Restating: Repeating the main thought expressed by the patient. It calls attention to something important that has been said. Eg : “You say that your mother left you when you were 5 years old”

15. 4. Clarification: Attempts to put vague ideas or unclear thoughts of the patient into words to enhance nurse’s understanding. Eg : I'm not sure what you mean. Could you tell me about that again ?"

16. 5. Reflection: Directing back the patient’s ideas, feelings, questions and content. Validates the nurse’s understanding of what the patient is saying and signifies empathy, interest and respect for the patient. Example: You are felling tense and anxious and it is related to the conversation you had with your son last night.

17. 6. Focusing: Statements that help the patient to expand on a single topic of importance. Eg : I think that we should talk more about your relationship with your father Allow the patient to discuss central issue

18. 7. Sharing Perceptions: Asking the patient to verify the nurse's understanding of what the patient is thinking or feeling. Eg : "You're smiling, but I sense that you're really angry with me."

19. 8. Theme Identification: Identification of underlying issues or problems experienced by the patient that emerge repeatedly during the course of the nurse-patient relationship. Eg:I noticed that you said, you have been hurt or rejected by the man. Do you think this is an underlying issue?

20. 9. Silence: Lack of verbal communication for therapeutic reason. Eg : sitting with the patient and non-verbally communicating interest and involvement.

21. 10. Humor: The discharge of energy through comic enjoyment of the imperfect.

22. 11. Informing: I nformation giving, is an essential nursing technique in which the nurse shares simple facts or information with the patient. Eg : I think you need to know more about your medication. 12. Suggesting: Presentation of alternative ideas, for the patient’s consideration relative to problem solving and is exploring alternative coping mechanisms.

23. Non therapeutic Communication Techniques Giving reassurance - may discourage client from further expression of feelings if client believes the feelings will only be downplayed or ridiculed Rejecting - refusing to consider client’s ideas or behavior Approving or disapproving - implies that the nurse has the right to pass judgment on the “goodness” or “badness” of client’s behavior

24. Non therapeutic Communication Techniques Agreeing or disagreeing - implies that the nurse has the right to pass judgment on whether client’s ideas or opinions are “right” or “wrong” Giving advice - implies that the nurse knows what is best for client and that client is incapable of any self-direction Probing - pushing for answers to issues the client does not wish to discuss causes client to feel used and valued only for what is shared with the nurse

25. Non therapeutic Communication Techniques Defending - to defend what client has criticized implies that client has no right to express ideas, opinions, or feelings Requesting an explanation - asking “why” implies that client must defend his or her behavior or feelings Indicating the existence of an external source of power - encourages client to project blame for his or her thoughts or behaviors on others Belittling feelings expressed - causes client to feel insignificant or unimportant

26. Non therapeutic Communication Techniques Making stereotyped comments, clichés, and trite expressions - these are meaningless in a nurse-client relationship Using denial - blocks discussion with client and avoids helping client identify and explore areas of difficulty Interpreting - results in the therapist’s telling client the meaning of his or her experience Introducing an unrelated topic - causes the nurse to take over the direction of the discussion

27. Touch Touch is a powerful communication tool It is very basic and primitive form of communication Appropriate use of communication is culturally determined It can elicit both negative and positive reactions, depending on the people involved and the circumstances of the interaction

28. Categories of Touch 1. Functional-Professional Impersonal and business-like Used to accomplish a task Eg : physician examining a client 2. Social-Polite Impersonal but it conveys an affirmation or acceptance of the other person Eg : Handshake 3. Friendship-Warmth Indicates a strong liking for the other person Eg : Laying one’s hand on the shoulder 4.Love- Intimacy Conveys an emotional attachment or attraction for another person. Eg : Engaging in strong emotional embrace. 5. Sexual-Arousal Touch at this level is an expression of physical attraction only.

29. THERAPEUTIC COMMUNICATION AND PROBLEM-SOLVING Goals are often achieved through use of the  problem-solving model:  Identify the client’s problem.  Promote discussion of desired changes. Discuss aspects that cannot realistically be changed and ways to cope with them more adaptively.  Discuss alternative strategies for creating changes the client desires to make.

30. THERAPEUTIC COMMUNICATION AND PROBLEM-SOLVING Weigh benefits and consequences of each alternative.  Help client select an alternative.  Encourage client to implement the change.  Provide positive feedback Help client evaluate outcomes of the change and make modifications as required.

31. THERAPEUTIC NURSE –PATIENT RELATIONSHIP

32. THERAPEUTIC NURSE –PATIENT RELATIONSHIP A relationship is defined as a state of being related between two individuals. In a therapeutic relationship the nurse and patient interact with each other in the health care system with the goal of assisting the patient to use personal resources to meet his or her unique needs. It is the foundation on which psychiatric nursing is established Therapeutic use of self is the instrument for delivery of care to client in need of psychosocial intervention

33. Components of the Nurse-patient Relationship Trust Rapport Warmth Genuine interest Empathy Acceptance Positive Regard Therapeutic Use of Self

34. Characteristics of Nurse Patient : Relationship Observation Understanding of behavior Communication Mutual growth Grow patient to his fullest potential Gain new coping and adaptation

35. Types of relationship Therapeutic Intimate Social Focuses on client’s needs, experiences, feelings, ideas. Goal oriented Emotional commitment May be sexual/ emotional intimacy Friendship Companion Uses small talk superficial

36. Phases of the Nurse-patient Relationship Pre- interaction phase Orientation phase Working phase Termination phase

37. Phases PRE-INTERACTION Self assessment, examine own feelings, fears, anxieties. Gather data about patient Plan for first meeting Analyze own professional strengths and limitations

38. Phases ORIENTATION – INTRODUCTORY PHASE establish trust, rapport and acceptance Establish communication Gather data about patient feelings Define patient problem Set goals

39. Phases THE WORKING PHASE – Gather further data Promote insight Facilitate behavioral change Provide opportunity for independent functioning Evaluate problems and goals redefine if necessary

40. Phases TERMINATION PHASE – RESOLUTION PHASE establish reality of separation Review progress of therapy Formulate plan for meeting future therapy needs

41. Obstacles to the Therapeutic Relationship Inappropriate Boundaries Encouraging dependence Non acceptance/Avoidance Resistance

42. References 1. Mary.C . Townsend (2013). Essentials of Psychiatric Mental Nursing. Sixth Edition. Philadelphia. F.A. Davis Company .   2.Kaplan and Sadock’s , (2012 ) Comprehensive text book of psychiatry. 9th Edition, Lippincott Williams and willkins , 3.https ://www.psychiatry.org/psychiatrists/practice/dsm

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