Therepeutic communication.pptx nursing 3rd year

Therepeutic communication.pptx nursing 3rd year

1. Topic: Therapeutic communication Prepared by : Miss Rabia Hanif Nursing Lecturer

2. COMMUNICATION COMMUNICATION is the process that people use to exchange information. Messages are simultaneously sent and received on two levels : Verbally through the use of words and Nonverbally by behaviors that accompany the words. Verbal communication consists of the words a person uses to speak to one or more listeners. Nonverbal communication is the behavior that accompanies verbal content such as body language, eye contact, facial expression, tone of voice, speed and hesitations in speech, grunts and groans, and distance from the listeners.

3. Content, Context and Process In verbal communication….. Content is the literal words that a person speaks. Context is the environment in which communication occurs and can include the time and the physical, social, emotional, and cultural environments. Process denotes all nonverbal messages that the speaker uses to give meaning and context to the message.

4. Therapeutic communication Therapeutic communication is an interpersonal interaction between the nurse and the client during which the nurse focuses on the client’s specific needs to promote an effective exchange of information. To have effective therapeutic communication, the nurse also must consider privacy and respect of boundaries , use of touch , and active listening and observation.

5. Conti…… Therapeutic communication can help nurses to accomplish many goals: Establish a therapeutic nurse–client relationship. Identify the most important client concern at that moment (the client-centered goal). Assess the client’s perception of the problem as it unfolds. This includes detailed actions (behaviors and messages) of the people involved and the client’s thoughts and feelings about the situation, others, and self. Facilitate the client’s expression of emotions. Teach the client and family necessary self-care skills. Recognize the client’s needs. Implement interventions designed to address the client’s needs. Guide the client toward identifying a plan of action to a satisfying and socially acceptable resolution.

6. Privacy and Respecting Boundaries People from the United States, Canada, and many Eastern , European nations generally observe FOUR DISTANCE ZONES: Intimate zone (0 to 18 inches between people): This amount of space is comfortable for parents with young children, people who mutually desire personal contact, or people whispering . Invasion of this intimate zone by anyone else is threatening and produces anxiety. Personal zone (18 to 36 inches): This distance is comfortable between family and friends who are talking. Social zone (4 to 12 feet): This distance is acceptable for communication in social, work, and business settings. Public zone (12 to 25 feet): This is an acceptable distance between a speaker and an audience, small groups, and other informal functions (Hall, 1963). Proxemics is the study of distance zones between people during communication.

7. Touch As intimacy increases, the need for distance decreases. Knapp (1980) identified five types of touch: Functional-professional touch is used in examinations or procedures such as when the nurse touches a client to assess skin turgor or a masseuse performs a massage. Social-polite touch is used in greeting , such as a handshake and the “air kisses” some women use to greet acquaintances, or when a gentle hand guides someone in the correct direction . Friendship-warmth touch involves a hug in greeting, an arm thrown around the shoulder of a good friend, or the backslapping some men u se to greet friends and relatives. Love-intimacy touch involves tight hugs and kisses between lovers or close relatives . Sexual-arousal touch is used by lovers.

8. Active Listening and Observation Active listening means refraining from other internal mental activities and concentrating exclusively on what the client says. Active observation means watching the speaker’s nonverbal actions as he or she communicates. Active listening and observation help the nurse to Recognize the issue that is most important to the client at this time. Know what further questions to ask the client . Use additional therapeutic communication techniques to guide the client to describe his or her perceptions fully . Understand the client’s perceptions of the issue instead of jumping to conclusions. Interpret and respond to the message objectively.

9. VERBAL COMMUNICATION SKILLS Using Concrete Messages Concrete messages are clear, direct, and easy to understand . They elicit more accurate responses and avoid the need to go back and rephrase unclear questions, which interrupts the flow of a therapeutic interaction. For example, “ What health symptoms caused you to come to the hospital today?” or “When was the last time you took your antidepressant medications?” Abstract messages are unclear patterns of words that often contain figures of speech that are difficult to interpret . They require the listener to interpret what the speaker is asking. For example , a nurse who wants to know why a client was admitted to the unit asks, “ How did you get here?”

10. Using Therapeutic Communication Techniques Accepting Broad opening Consensual validation Encouraging comparison Encouraging description of perceptions Exploring Focusing Formulating a plan of action General leads Giving information Giving recognition Making observation Offering self Placing event in time or sequence Presenting reality Reflecting Restating Seeking information Silence Suggesting collaboration Summarizing Translating into feelings Verbalizing the implied Voicing doubt

11. NONTHERAPEUTIC COMMUNICATION TECHNIQUES Indicating the existence of an external source Interpreting Introducing an unrelated topic Making stereotyped comments Probing Reassuring Rejecting Requesting an explanation Testing Using denial

12. Interpreting Signals or Cues To understand what a client means , the nurse watches and listens carefully for cues. Cues (overt and covert) are verbal or nonverbal messages that signal key words or issues for the clien t. Finding cues is a function of active listening. The following example illustrates questions the nurse might ask when responding to a client’s cue: Client : “I had a boyfriend when I was younger.” Nurse : “You had a boyfriend?” (reflecting) “Tell me about you and your boyfriend.” (encouraging description) “How old were you when you had this boyfriend?” (placing events in time or sequence) A client has difficulty attending to a conversation and drifts into a rambling discussion or a flight of ideas, the nurse listens carefully for a theme (theme of sadness, loss of control, hopelessness and suicidal ideation) or a topic around which the client composes his or her words. Other word patterns that need further clarification for meaning include metaphors, proverbs, and clichés . When a client uses these figures of speech, the nurse must follow up with questions to clarify what the client is trying to say.

13. Non-verbal communication Nonverbal communication is the behavior a person exhibits while delivering verbal content. It includes facial expression, eye contact, space, time, boundaries, and body movements. Nonverbal communication is as important as, if not more so than, verbal communication. It is estimated that one third of meaning is transmitted by words and two thirds is communicated nonverbally.

14. Knapp and Hall (2009) listed the ways in which nonverbal messages accompany verbal messages Accent: Using flashing eyes or hand movements . Complement: Giving quizzical looks, nodding. Contradict: Rolling eyes to demonstrate that the meaning is the opposite of what one is saying. Regulate: Taking a deep breat h to demonstrate readiness to speak, using “and uh” to signal the wish to continue speaking. Repeat: Using nonverbal behaviors to augment the verbal message, such as shrugging after saying “Who knows ?” Substitute: Using culturally determined body movements that stand in for words, such as pumping the arm up and down with a closed fist to indicate success .

15. Facial Expression Facial expressions can be categorized into expressive, impassive, and confusing: An expressive face portrays the person’s moment-by moment thoughts, feelings, and needs. These expressions may be evident even when the person does not want to reveal his or her emotions. An Impassive face is frozen into an emotionless deadpan expression similar to a mask . A Confusing facial expression is one that is the opposite of what the person wants to convey. A person who is verbally expressing sad or angry feelings while smiling is exhibiting a confusing facial expression.

16. Body language Body language ( gestures, postures, movements, and body positions ) is a nonverbal form of communication. Closed body positions, such as crossed legs or arms folded across the chest, indicate that the interaction might threaten the listener who is defensive or not accepting. A better, more accepting body position is to sit facing the client with both feet on the floor, knees parallel, hands at the side of the body, and legs uncrossed or crossed only at the ankle. This open posture demonstrates unconditional positive regard, trust, care, and acceptance.

17. Positioning The positioning of the nurse and client in relation to each other is also important. Sitting beside or across from the client can put the client at ease , whereas sitting behind a desk (creating a physical barrier) can increase the formality of the setting and may decrease the client’s willingness to open up and communicate freely.

18. Vocal cues Vocal cues are nonverbal sound signals transmitted along with the content : Voice volume, tone, pitch, intensity, emphasis, speed, and pauses augment the sender’s message. Volume , the loudness of the voice, can indicate anger, fear, happiness, or deafness. Tone can indicate whether someone is relaxed, agitated, or bored. Pitch varies from shrill and high to low and threatening. Intensity is the power, severity, and strength behind the words, indicating the importance of the message. Emphasis refers to accents on words or phrases that highlight the subject or give insight into the topic. Speed is the number of words spoken per minute. Pauses also contribute to the message, often adding emphasis or feeling.

19. Conti….. Circumstantiality The use of extraneous words with long, tedious descriptions is called circumstantiality . It can indicate the client is confused about what is important or is a poor historian. Eye contact The eyes have been called the mirror of the soul because they often reflect our emotions. Messages that the eyes give include humor, interest, puzzlement, hatred, happiness, sadness, horror, warning, and pleading . Silence Silence or long pauses in communication may indicate many different things. The client may be depressed and struggling to find the energy to talk. Sometimes pauses indicate the client is thoughtfully considering the question before responding.

20. Conti…. UNDERSTANDING THE MEANING OF COMMUNICATION Few messages in social and therapeutic communication have only one level of meaning; messages often contain more meaning than just the spoken words. The nurse must try to discover all the meaning in the client’s communication. UNDERSTANDING CONTEXT Understanding the context of communication is extremely important in accurately identifying the meaning of a message . Think of the difference in the meaning of “I’m going to kill you!” when stated in two different contexts: anger during an argument and when one friend discovers another is planning a surprise party for him or her. UNDERSTANDING SPIRITUALITY Spirituality is a client’s belief about life, health, illness, death, and one’s relationship to the universe.

21. Goals The nurse uses all the therapeutic communication techniques and skills previously described to help achieve the following goals: Establish rapport with the client by being empathetic, genuine, caring, and unconditionally accepting of the client regardless of his or her behavior or beliefs. Actively listen to the client to identify the issues of concern and to formulate a client-centered goal for the interaction . Gain an in-depth understanding of the client’s perception of the issue, and foster empathy in the nurse–client relationship. Explore the client’s thoughts and feelings . Facilitate the client’s expression of thoughts and feelings. Guide the client to develop new skills in problem solving. Promote the client’s evaluation of solutions.

22. Assertive communication Assertive communication is the ability to express positive and negative ideas and feelings in an open, honest, and direct way (Hopkins, 2008). It recognizes the rights of both parties, and is useful in a variety of situations, such as resolving conflicts, solving problems, and expressing feelings or thoughts that are difficult for some people to express.

23. Conti…. Assertive communication can help a person deal with issues with coworkers, family, or friends. It is particularly helpful for people who have difficulty refusing another’s request, expressing emotions of anger or frustration, or dealing with persons of authority. Assertive communication works best when the speaker is calm; makes specific, factual statements; and focuses on “I” statements . For example , one of the nurses on your unit is always a few minutes late to work, arriving in a rush and disrupting change-of-shift report.

24. Types of responses There are four types of responses that coworkers can have to this situation : Aggressive: After saying nothing for several days, one nurse jumps up and yells, “ You’re always late! That is so rude ! Why can’t you be on time like everyone else?” Then the nurse stomps out of the room, leaving everyone uncomfortable. Passive-aggressive: A coworker says to another nurse, “ So nice of her to join us! Aren’t we lucky.” Everyone sits in uncomfortable silence. Passive: One nurse doesn’t say anything at the time, but later tells coworkers, “She’s always late. I had to tell her what she missed. I have so much work of my own to do.” But this nurse doesn’t say anything to the nurse who was late . Assertive : After report, one nurse says, “When you are late, report is disrupted, and I don’t like having to repeat information that was already discussed.” This nurse has communicated feelings about the specific situation in a calm manner with no accusations or inflammatory comments .

25. Conti…… Using assertive communication does not guarantee that the situation will chang e, but it does allow the speaker to express honest feelings in an open and direct way that is still respectful of the other person. Sometimes, people have difficulty saying no or refusing requests from others. Later, the person may regret saying yes and feel overburdened or even resentful. Using assertive communication can help the person say no politely but firmly , even when the person making the request is persistent in the request.

26. Conti….. Nurse 1: “Can you work for me next Saturday?” Nurse 2: “No, I can’t work for you next Saturday.” Nurse 1: “Oh please, can’t you help me? I have tickets for a concert that I really want to see.” Nurse 2: “I can’t work for you next Saturday.” Nurse 1: “Why not? I heard you say you weren’t doing anything special this weekend. Please, I’ll never ask again. Please? I’ll do something special for you.” Nurse 2: “I can’t work for you next Saturday .” This is called the “ broken record technique .” Instead of responding to additional information, such as concert tickets, not having plans, or emotional pleas, the speaker simply repeats the response without justifying or explaining the response.

27. Broken record technique The broken record technique is one of the most well-known assertiveness techniques out there and, simply put, it's all about  repeating the point you're making until the other person pays attention to it. Please keep in mind that when you do this, it's extremely important that you stay calm and present.