Therapeutic communication - PowerPoint by 8BUCvL

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									Therapeutic
Communication

Prepared by Sally McDonald
Revised by Tim Corbett
Helping vs Social
Relationships
   HELPING                   SOCIAL
   Care                      Care
   Trust                     Trust
   Growth                    Growth
   Purposeful/intention
    al                        Spontaneous
   Unequal sharing           Usually equal or
   Focus on Client’s          near equal sharing
    needs                     Focus on needs of
   Time limited                both individuals
                              Ongoing
    Locus of Control

   GIVING HELP              NEEDING HELP
   Feeling   important      Feeling unimportant
                              or inadequate
   Feeling   useful
                             Feeling useless or
   Feeling   powerful        depressed
   Feeling   gratified      Feeling powerless
   Feeling   happy          Feeling frightened
                              or embarrassed
                             Feeling sad
                              or angry
Phases of Helping
Relationships
   Orientation Phase

   Working Phase

   Termination Phase
Orientation Phase

   “getting to know you” phase
   setting the tone
   making introductions
   establishing roles
   reaching agreement on goals
   developing trust
Working Phase

   “problem solving” phase
   attending to client’s needs
   Nurse in role of teacher/counselor
   encouraging active participation by client
   gathering further data
   assisting client in decision making
   facilitating change
   Evaluate problems & goals
Termination Phase

 reviewing & summarizing goals met
  and progress made
 acknowledge feelings of loss

 reassuring clients with issues such as,

  “How will this problem/disease affect
   my life ?” or
 “What do I need to change ?”
Active Listening

   3 Phases
   restatement involves repeating or
    paraphrasing the words of the client
   reflection is verbalizing both the content
    and the implied feelings of the client’s
    message
   clarification is summarizing the client’s
    thoughts & feelings & resolving confusion
Active Listening

   STOP TALKING
   demonstrate that you want to listen
   remove distractions
   be patient
   STOP TALKING
Techniques
 Offering Self-making yourself available on
  an unconditional basis-
 “I’ll stay with you awhile”
 Giving Recognition-acknowledging client’s
  thoughts and feelings
 Sharing Observations-”You seem tense and
  upset”
 Encouraging Descriptions-ask client to
  verbalize experience-
   “Tell me what is happening now”
Techniques

   Restating-repeating the main idea
   Sequencing-placing events in
    chronological order
   Reflecting-referring questions,
    thoughts, feelings back to client-
    “What do you think you should do?”
Assertive Communication

   “I” Statements allow people to ‘own’
    (take responsibility for) their own
    thoughts & feelings
   assertiveness involves taking a risk
NONVERBAL CUES

   80-90% of any message is carried
    nonverbally by our body language
    (facial expression, paralanguage, and
    tone, pitch, and volume of voice
NONVERBAL CUES

 professional attire
 sit arm’s length away

 relaxed but attentive posture
NONVERBAL CUES

   facial expressions and tone
    should be friendly & interested
   use direct eye contact & match your
    eye contact with the patient’s
   pay attention to body language of the
    patient as well as your own
INTERVIEWING
TECHNIQUES
   the purpose of the interview is to obtain
    accurate & thorough information
   put your client at ease as they may feel
    uncomfortable about revealing sensitive
    information to you
   explaining your format helps clients accept
    & understand the purpose of the interview
INTERVIEWING
TECHNIQUES
   in general, use open-ended questions
   however, to obtain specific information,
    closed-ended questions are preferable
   validate information
   clarify responses
   use reflective questions/comments
     & paraphrasing
Progression of
the Interview
   Broad Openings- such as
    “Tell me about yourself” are designed
    to allow the client to relate his or her
    story in a way that is comfortable
Progression of
the Interview
   Open-Ended Questions
    encourage the client to elaborate or
    give explanations (for example,
    “What happened yesterday?”)
   they provide direction & keep the
    conversation focused
Progression of
the Interview
   Closed-Ended Questions
    can be answered with 1-2 words and
    can be useful in obtaining specific
    types of information, such as
    “What is today’s date?”
EFFECTIVE
INTERVIEWING
   as a professional nurse, you will spend
    about half of your time obtaining
    information from clients & colleagues
   excellent communication as well as
    interviewing skills are fundamental,
    yet require years of practice
WHY, WHAT, HOW

   why do you need the information?
   how will the information I am seeking
    direct me in helping my client?
   how will you phrase your questions?
Who to Ask?

   if the client is able to speak, ask him/her
   family perspectives may also be important
   written consent may be required to question
    concurrent/previous healthcare providers
   be courteous and respectful
   never forget client confidentiality
“Why” Questions

   offensive misuse of ‘why’ appears
    threatening and confrontational and
    puts clients on the defensive
   they can interfere with developing a
    therapeutic relationship & are seldom
    considered therapeutic
Conveying
Upsetting Information
   The SPIKES Model developed by
    Radziewicz & Baile (2001)
   Setting
   Perception
   Invitation
   Knowledge emotions
   Summary
Setting

   private & comfortable
   invite others, such as family members
Perception

   refers to what client and others
    already know useful in uncovering
    misinformation
Invitation

   For example, the statement,
    “Would you like me to explain more
     about what happened?’
Knowledge

   gradually dispense information
    assessing client’s ability to cope with it
   The family may insist that the client
    not be told difficult news
Emotions

   let client vent while you remain calm
   keep in mind Stages of Grief & Loss
   may need to set limits on
    inappropriate /harmful behavior
Summary

   review all important information with
    the client and family
   may need to repeat information more
    than once
Self-Disclosure

   Use self disclosure to help clients open up
    to you – not to meet your own needs
   Keep disclosures brief
   Don’t imply that your experience is exactly
    the same as the client’s
   Only self-disclose about situations that you
    have mastered
Self-Disclosure

   Monitor your own comfort with
     self-disclosure
   Respect your client’s needs for privacy
   Remember that there are cultural
    variations in the amount of self-
    disclosure considered appropriate
   Identify risks and benefits of self
    disclosure
Therapeutic Versus
Nontherapeutic Communication
   THERAPEUTIC
- Facilitates transformation of working
  nurse-patient relationship
- Relationship allows for adequate &
  accurate data collection & assessment
- Performed with & not for patient
Therapeutic Versus
Nontherapeutic Communication
   NONTHERAPEUTIC
- Hinders relationship formation
- Prevents patient from becoming
  mutual partner & relegates him/her to
  passive recipient of care

								
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