Unit 4- Therapuetic communication.pptx coomunication, process recording

Communication refers to the giving and receiving of information. Communication is the means by which people influence the behaviour of another, leading to the successful outcome of nursing intervention.

1. THERAPEUTIC COMMUNICATION AND NURSE-PATIENT RELATIONSHIP

2. Communication refers to the giving and receiving of information. Communication is the means by which people influence the behaviour of another, leading to the successful outcome of nursing intervention. COMMUNICATION

3. THERAPEUTIC COMMUNICATION Therapeutic communication 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.

4. GOALS 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

5. PRINCIPLES OR 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, Assess the patient's intellectual competence to determine the level of understanding

6. THERAPEUTIC COMMUNICATION TECHNIQUES 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 non-verbal communication convey to the patient that he is being listened to and understood. Therapeutic value : Non-verbally communicates to the patient the nurse's interest and acceptance.

7. 2. Broad openings: Encouraging the patient to select topics for discussion. For example, “What are you thinking about?” Therapeutic value : Indicates acceptance by the nurse and the value of patient's initiative. 3. Restating: Repeating the main thought expressed by the patient. For example, “You say that your mother left you when you were 5-year-old.” Therapeutic value : Indicates that the nurse is listening and validates, reinforces or calls attention to something important that has been said.

8. 4. Clarification: Attempting to put vague ideas or unclear thoughts of the patient into words to enhance the nurse's understanding or asking the patient to explain what he means. For example, “I am not sure what you mean. Could you tell me about that 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.

9. 5. Reflection: Directing back the patient's ideas, feelings, questions and content. For example, “You are feeling tense and anxious 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.

10. 6. Humour: The discharge of energy through comic enjoyment of the imperfect. For example, “That gives a whole new meaning to the word ‘nervous’,” said with shared kidding between the 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 sublimation.

11. 7. Informing: The skill of information giving. For example, “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. 8. Focusing: Questions or statements that help the patient expand on a topic of importance. For example, “I think that 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-directed.

12. 9. Sharing perceptions: Asking the patient to verify the nurses understanding of what the patient is thinking or feeling. For example, “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 . 10. Theme identification: This involves identification of underlying issues or problems experienced by the patient that emerge repeatedly during the course of the nurse-patient relationship. For example, “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.

13. 11. Silence: Lack of verbal communication for a therapeutic reason. For example, sitting with a patient 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.

14. 12. 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.

15. 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.  THERAPEUTIC NURSE-PATIENT RELATIONSHIP

16. TYPES OF RELATIONSHIPS Social relationships Intimate relationships Therapeutic relationships 

17. Social Relationships 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.

18. 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. Therapeutic Relationships The therapeutic relationship between nurse and the patient differs from both a social and an intimate relationship in that the nurse maximizes inner communication skills, understanding of human behaviour and personal strengths, in order to enhance the patient's growth. The focus of the relationship is on the patient's ideas, experiences and feelings.

19. Rapport Rapport is a relationship or communication, especially when useful and harmonious. It is the crux of a therapeutic relationship between the nurse and the patient . Goals of therapeutic relationship » Facilitating communication of distressing thoughts and feelings » Assisting the patient with problem-solving » Helping patients examine self-defeating behaviours and test alternatives » Promoting self-care and independence COMPONENTS OF THERAPEUTIC NURSE-PATIENT RELATIONSHIP

20. Empathy Empathy is an ability to feel with the patient while retaining the ability to critically analyze the situation. It is the ability to put oneself in another person's circumstances and feelings. The nurse need not necessarily have to experience it, but has to be able to imagine the feelings associated with the experience. Sympathy Sympathy is often confused with empathy. In sympathy, the nurse actually feels what the patient feels but in the process objectivity is lost, and the nurse becomes focused on relief of personal distress rather than on assisting the patient to resolve the problem

21. Warmth Warmth is the ability to help the patient feel cared for and comfortable. It shows acceptance of the patient as a unique individual. It involves a non-possessive caring for the patient as a person and a willingness to share the patient's joys and sorrows. Genuineness Genuineness involves being one's own self. This implies that the nurse is aware of her thoughts, feelings, values and their relevance in the immediate interaction with a patient. It is also important that the nurse's verbal and non-verbal communication corresponds with each other.

22. PHASES AND TASKS OF THERAPEUTIC RELATIONSHIP Four phases of relationship process have been identified: Pre-interaction phase Introductory or orientation phase Working phase Termination phase

23. Pre-interaction Phase This phase begins when the nurse is assigned to initiate a therapeutic relationship and includes all that the nurse thinks, feels or does immediately prior to the first interaction with the patient. The nurse's initial task is one of self-exploration. Nurse's tasks in the pre-interaction phase Explore own feelings, fantasies and fears Analyse own professional strengths and limitations Gather data about patient whenever possible Plan for first meeting with patient

24. Introductory or Orientation Phase It is during the introductory phase that the nurse and the patient meet for the first time. One of the nurse's primary concerns is to find out why the patient sought help. Nurse's tasks in the orientation phase Establish rapport, trust and acceptance Establish communication; assist in the verbal expression of thoughts and feelings Gather data, including the patient's feelings, strengths and weaknesses Define patient's problems; set priorities for nursing intervention Mutually set goals

25. Working Phase Most of the therapeutic work is carried out during the working phase. The nurse and the patient explore relevant stressors and promote the development of insight in the patient. Nurse's tasks in the working phase Gather further data; explore relevant stressors Promote patient's development of insight and use of constructive coping mechanisms Facilitate behavioural change; encourage him to evaluate the results of his behaviour

26. Termination Phase This is the most difficult, but most important phase of the therapeutic nurse-patient relationship. The goal of this phase is to bring a therapeutic end to the relationship. Nurse's Tasks in the Termination Phase Establish reality of separation Mutually explore feelings of rejection, loss, sadness, anger and related behaviour Review progress of therapy and attainment of goals Formulate plans for meeting future therapy needs

27. THERAPEUTIC IMPASSES Therapeutic impasses are blocks in the progress of the nurse-patient relationship. Impasses provoke intense feelings in both the nurse and the patient, which may range from anxiety and apprehension to frustration, love or intense anger.

28. Resistance: Resistance is the patient's attempt to remain unaware of anxiety producing aspects within the self. Transference : Transference is an unconscious response in which the patient experiences feelings and attitudes toward the nurse that were originally associated with significant figures in the patient's early life. Counter transference: refers to a specific emotional response by the nurse towards the patient that is inappropriate to the content and context of the therapeutic relationship or inappropriate in its emotional intensity.

29. Interventions to overcome Therapeutic Impasses Nurse must have knowledge of the impasses and recognize behaviours that indicate their existence. Nurse must reflect on feelings, explore reasons behind such behaviour. Co-workers are more likely than others to recognize the phenomenon initially and give feedback to the nurse about it. Nurses must examine their strengths, weaknesses, prejudices, and values before they can interact more appropriately with patients.

30. The transference reactions of patients must also be examined, gently but directly. Nurses must be open and clear about their genuine reactions when patients misperceive behaviour. Nurses should also state actions that they can and cannot take to meet patient's needs. Limit setting is useful when patients act inappropriately towards the nurse. Maintain open communication with her supervisor, who can then guide her in making adequate progress in handling such resistance reactions.

31. PROCESS RECORDING Definition: Process recording is a written account or verbatim recording of all that transpired, during and immediately following the nurse-patient interaction. In other words, it is the recording of the conversation during the interaction or the interview between the nurse and the patient in the psychiatric setup with the nurse's inference .

32. PURPOSE AND USES assists the nurse or student to plan, structure and evaluate the interaction on a conscious rather than an intuitive level assists her to gain competency in interpreting and synthesizing raw data under supervision helps to consciously apply theory to practice helps her to develop an increased awareness of her habitual, verbal and non-verbal communication pattern and the effect of those patterns on others helps the nurse to learn to identify thoughts and feelings in relation to self and others

33. PREREQUISITES FOR PROCESS RECORDING Physical setting Getting consent of the patient for the possibility of cassette recording Confidentiality

34. Suggested Outlines for Process Recording Introductory Material This should include a short description of the patient, his name, age, educational level, health problems and length of stay in the hospital. The date, time, place of interaction and a short description of the milieu of the ward immediately prior to the interaction will be helpful in understanding the thoughts and feelings of the patient

35. Objectives Objectives should be formulated prior to meeting. It should be specific, readily measurable change in the patient behaviour and function as a guide for interaction. Context of the Interaction Describe where the interaction took place, activities involving the patient that occurred before the interaction, the patient's physical appearance and how the interaction began, i.e. whether the patient approached you or you initiated the interaction.

36. Record of interaction between nurse and the patient This should include truthful recording of what the nurse said and did and what the patient said and did, including any non-verbal behaviour of the patient, such as changing the position, looking at various things, eye contact, biting the nails, pacing, tone of voice, rate of speech and changes in facial expressions. Analysis of the Interaction An analysis of the interaction should include the interpretation of the verbal and non-verbal behaviour and patient's thoughts and feelings as evident from the process.