chapter 6 therapeutic communication
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Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins
Chapter 6
Therapeutic Communication
Chapter 6
Therapeutic Communication
Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins
CommunicationCommunication
• Exchange of information
• Verbal– Content: literal words spoken– Context: environment, circumstances, situation in
which communication occurs
• Nonverbal– Process: all messages used to give meaning, context
to message– Congruent or incongruent message
Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins
Therapeutic CommunicationTherapeutic Communication
• Interpersonal interactions; focus on patient’s needs
• Need for privacy
• Encompasses goals that facilitate the nursing process
Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins
Therapeutic Communication (cont.)Therapeutic Communication (cont.)
• Goals of therapeutic communication– Establish therapeutic relationship– Identify patient’s most important concerns; assess
patient’s perceptions– Facilitate patient’s expression of emotions – Teach patient, family necessary self-care skills – Recognize patient’s needs; implement interventions
to address patient’s needs – Guide patient toward acceptable solutions
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Therapeutic Communication (cont.)Therapeutic Communication (cont.)
• Touch
– Five types: functional/professional; social–polite; friendship–warmth; love–intimacy; sexual–arousal
– Comforting and supportive; also possible invasion of intimate and personal space
Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins
QuestionQuestion
• Tell whether the following statement is true or false?
• A distance of 2 feet between the nurse and patient is adequate for promoting comfortable therapeutic communication.
Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins
AnswerAnswer
• False
• Rationale: For effective therapeutic communication, a distance of 3 to 6 feet between the nurse and patient would be most appropriate.
Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins
Verbal Communication SkillsVerbal Communication Skills
• Need for concrete, not abstract, messages
• Techniques (see Table 6.1)– Exploring, focusing, restating, reflecting promotes
discussion of feelings or concerns in more depth
– Other techniques useful in focusing or clarifying what is being said
– Feedback via making an observation or presenting reality
Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins
Verbal Communication Skills (cont.)Verbal Communication Skills (cont.)
• Avoidance of nontherapeutic techniques (see Table 6.2)
– Advising, belittling, challenging, probing, reassuring
• Interpretation of signals or cues
– Overt
– Covert (themes, metaphors, proverbs, clichés)
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Nonverbal Communication SkillsNonverbal Communication Skills• Facial expression
– Expressive
– Impassive
– Confusing
• Body language– Open body position
– Closed body position
Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins
Nonverbal Communication Skills (cont.)Nonverbal Communication Skills (cont.)
• Vocal cues
• Eye contact
• Silence
Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins
Therapeutic Communication (cont.)Therapeutic Communication (cont.)
• Respect for boundaries
– Distance zones• Intimate (0 to 18 inches)• Personal (18 to 36 inches)• Social (4 to 12 feet)• Public (12 to 25 feet)
– Therapeutic communication: most comfortable when nurse and patient are 3 to 6 feet apart
Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins
Therapeutic Communication (cont.)Therapeutic Communication (cont.)
• Active listening (concentrating exclusively on what patient says)
• Active observation (watching nonverbal actions as speaker communicates)
Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins
Understanding Meaning, Context, and Spirituality of CommunicationUnderstanding Meaning, Context, and Spirituality of Communication
• Meaning: usually more meaning than just spoken word
• Context
– Validation with client of verbal, nonverbal information
– Who, what, when, how, why
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Understanding Meaning, Context, and Spirituality of Communication (cont.)Understanding Meaning, Context, and Spirituality of Communication (cont.)
• Spirituality
– Self-awareness of own spiritual beliefs
– Need for objectivity and nonjudgmental attitude about patient’s beliefs
Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins
Cultural ConsiderationsCultural Considerations
• Need for awareness of cultural differences– Speech patterns, habits– Styles of speech, expression– Eye contact– Touch– Concept of time– Health, health care
Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins
QuestionQuestion
• Which of the following would be a nontherapeutic communication technique?
– A. Reassuring
– B. Reflecting
– C. Focusing
– D. Exploring
Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins
AnswerAnswer
• A. Reassuring
• Rationale: Reassuring is a nontherapeutic technique because it attempts to dispel the patient’s feelings.
– Reflecting, focusing, and exploring are examples of therapeutic communication techniques.
Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins
Therapeutic Communication SessionTherapeutic Communication Session
• Goals– Establishing rapport– Identifying issues of concern – Being empathetic, genuine, caring, unconditionally
accepting of the person– Understanding patient’s perception– Exploring patient’s thoughts, feelings– Developing problem-solving skills– Promoting patient’s evaluation of solutions
Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins
Therapeutic Communication Session (cont.)Therapeutic Communication Session (cont.)
• Initiation of session– Introduction– Establishment of contract for relationship – Identification of major concern
• Nondirective role (broad-opening, open-ended questions)
• Directive role (direct yes/no questions; usually for patients with suicidal thoughts, in crisis, or who are out of touch with reality)
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Therapeutic Communication Session (cont.)Therapeutic Communication Session (cont.)• Proper phrasing of questions
– Clarification
– Identification of patient’s avoidance of anxiety-producing topic
• Guidance in problem-solving, empowerment to change
Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins
Assertive CommunicationAssertive Communication
• Expression of positive and negative feelings/ideas in open, honest, direct way– Calm, specific factual statements– Focus on “I” statements
• Possible responses– Aggressive– Passive–aggressive– Passive– Assertive
Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins
Community-Based Care Community-Based Care • Nurses increasingly caring for high-risk patients in homes;
families becoming more responsible for primary prevention
• Therapeutic communication techniques and skills are essential for caring for patients in the community.
• Increased self-awareness, knowledge needed about cultural differences; sensitivity to beliefs, behaviors, feelings of others
• Collaboration with patient and family as well as other health-care providers
Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins
QuestionQuestion
• Tell whether the following statement is true or false?
• Assertive communication focuses on identifying negative feelings.
Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins
AnswerAnswer
• False
• Rationale: Assertive communication focuses on the expression of positive and negative feelings or ideas in an open, honest, direct manner.
Copyright © 2014 Wolters Kluwer Health | Lippincott Williams & Wilkins
Self-Awareness Issues Self-Awareness Issues
• Nonverbal communication: as important as verbal
• Therapeutic communication influential in effectiveness of interventions
• Awareness of own communication is first step in improving communication
– Ask for feedback from colleagues
– Examine own communication skills
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