Introduction to Therapeutic Communication by HC120212225925

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									  Introduction to

        Nurs 200
Michelle Jocson MSN MED RN
   Sheryl Abelew MSN RN
         Class Objectives

   Discuss elements of professional
   Discuss the five levels of communication
    that nurses use in practice.
   Discuss therapeutic and non-therapeutic
    communication techniques.
   Identify significant features and
    therapeutic outcomes of nurse-client
    helping relationships.
    Therapeutic Communication
   Is a goal directed and focused
    dialogue between the nurse and the

   The goal of this dialogue is fitted to
    the needs of the client and designed
    to allow the client to express
    themselves freely.
    Professional Communication
    How the nurse initially greets the
    client and how his/her actions can
    have a lasting impression on the
    client and the family.
     Elements of Professional
 Courtesy- say hello, goodbye,
  knock on doors, introduction,
  make eye contact, smile
 Privacy and confidentiality-

  safeguard the client’s rights
  to privacy
      Elements of Professional
 Autonomy-self-directed and
  independent accomplishing goals
  and advocating for others
 Assertiveness-often contain ‘I’

  messages, feelings of security,
  competence, honesty
    Five Levels of Communication
   Interpersonal Communication -
    One-one, face to face interaction between
    the nurse and another person

   Transpersonal Communication-
    Interaction that occurs within a person’s
    spiritual domain (prayer, meditation)
    Five Levels of Communication
   Small-Group Communication-
    Interaction that occurs when a small number of
    people meet and share a common goal
    (committee, unit in-services)
   Intrapersonal Communication-
    Powerful form of communication that occurs
    within an individual (self-talk-nurses need to try
    to replace negative talk with positive thoughts)
   Public Communication-
    Interaction with an audience (requires nurses to
    use eye contact, gestures, etc)
    Types of Therapeutic Communication

   Active Listening- attentive to what the
    client is saying verbally and non-verbally

   Share observations- make comments on
    how the individual looks, sounds or acts

   Share empathy- be sensitive to the client

   Share hope- convey a sense of possibility
    Types of Therapeutic Communication
   Share humor- has a positive effect on an
    individual. Ensure the client understands
    what is being said
   Sharing feelings- help clients to share
    feelings by observing and encouraging
   Use touch- bring the sense of caring by
    holding a client’s hand
   Use silence- is useful in allowing the client
    to think and gain some insight into the
    situation. Listening is crucial.
        Therapeutic Communication
   Ask relevant questions- ask questions one
    at a time, to explore the topic before
    going on
   Provide information- provide information
    that the client needs to know helps to
    empower the client
   Paraphrasing- by restating the client’s
    message, the client knows that the nurse
    is listening
   Clarifying-assess whether the client
    understood the information
        Therapeutic Communication
   Focusing-focus on key issues in the
   Summarizing-brings s sense of closure to
    the conversation
   Self disclosing- way of showing the client
    that the information is understood and
    shows respect for the client
   Confronting-help the client realize his/her
    inconsistencies in feelings, attitudes, or
    NON-Therapeutic Communication
 Asking personal questions- asking
  questions that are not pertinent to
  the clients situation
 Give personal opinions-it takes the

  decision making power away from
  the client
 Change the subject-tends to block

  further communication
     NON-Therapeutic Communication
 Automatic responses-shows the
  nurse is not taking the situation
 False reassurance-offering

  reassurance not supported by facts
  may do more harm than good
 Sympathy-subjective and prevents a

  clear picture of the client’s situation
    NON-Therapeutic Communication

 Ask for explanation-questions can
  cause resentment
 Approval or disapproval-

  approval/disapproval sends the
  message that the nurse has the right
  to make judgments
 Defensive responses-implies the

  client has no rights to an opinion
Nontherapeutic Communication Techniques

   Passive or aggressive responses-
    passive responses avoid the issues
    and aggressive responses maybe

   Arguing-implies the client is lying or
    How is information collected from
               the client?

   Interview is a method to collect data
    about the client.

   An interview is an organized conversation
    with the client to obtain the client’s history
    and information about the current illness/
 Types of Interview Techniques
   Open-ended questions- the client
  is able to tell his/her full story about
  the health problem. The nurse
  establishes concern about the client.
 Nurse may ask the client to add
  more information by saying: ‘Is there
  anything else’?
Types of Interview Techniques
   Closed-ended questions- limits
    the answer to one or two word such
    as “yes” or “no”. Used when the
    nurse wants to know a specific
    answer to a question such as: Are
    you experiencing pain now?
Types of Interview Techniques
   Focused questions- when there
    is an established, strong
    relationship, these questions can
    result in lengthier responses.
    Use with a resistant client. Nurse
    may say: Can you describe your
     Phases of the Interview
 There are 3 phases which include:
 a) Orientation phase

 b) Working phase

 c) Termination phase
            Orientation phase
   Orientation phase- the nurse introduces
    his/herself to the client and explains the
    purpose of the interview. The nurses
    explains why the data is being collected.
    The nurse needs to understand the client’s
    needs. Trust and confidentiality must be
    conveyed. Professionalism is extremely
              Working Phase
   Working phase- the nurses asks questions
    to obtain data for the purpose of
    developing a nursing care plan. In this
    phase, the nurse uses such strategies as
    silence, listening, paraphrasing, clarifying
    etc. to facilitate communication.
          Termination Phase
   C)  Termination phase- client needs to
    know the interview is coming to an end.
    The nurse can say that there are just a
    few more questions to ask. The nurse
    summarizes the information and asks the
    client if this information is accurate.

   Note: Nurses become skilled at
    interviewing with experience.
         Basic Elements of the
        Communication Process
   Referent-motivates a person to
    communicate with another
   Sender- person who sends the message
    and Receiver-person who receives and
    decodes the message
   Message-content of the communication
   Channels-means of conveying and
    receiving messages through visual,
    auditory, and tactile senses
       Basic Elements of the
      Communication Process
 Feedback- message returned by the
 Interpersonal Variables-factors that

  influence communication such as
  perception, interpretation,
 Environment-the setting for the

  sender-receiver interaction
         The Nursing Process and
        Therapeutic Communication
   Assessment – gather information about
    the client’s health condition
   Nursing Diagnosis-identify the client’s
    health problem (s)
   Planning- establish goals, desired
    outcomes and identify appropriate nursing
   Implementation- carries out the nursing
   Evaluation- determines if client goals were
    met and outcomes achieved

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