Therapeutic Communication

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Therapeutic Communication

• Prepared by Sally McDonald
• Revised by Tim Corbett

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Helping vs Social Relationships

• HELPING
• Care
• Trust
• Growth
• Purposeful/intentional
• Unequal sharing
• Focus on Clients needs
• Time limited

• SOCIAL
• Care
• Trust
• Growth
• Spontaneous
• Usually equal or near equal sharing
• Focus on needs of
• both individuals
• Ongoing

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Locus of Control

• GIVING HELP
• Feeling important
• Feeling useful
• Feeling powerful
• Feeling gratified
• Feeling happy

• NEEDING HELP
• Feeling unimportant or inadequate
• Feeling useless or depressed
• Feeling powerless
• Feeling frightened or embarrassed
• Feeling sad
• or angry

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Phases of Helping Relationships

• Orientation Phase
• Working Phase
• Termination Phase

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Orientation Phase

• getting to know you phase
• setting the tone
• making introductions
• establishing roles
• reaching agreement on goals
• developing trust

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Working Phase

• problem solving phase
• attending to clients 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

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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 ?

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Communication Techniques

• Validating/Clarifying
• Reflecting
• Sequencing
• Sharing observations
• Acknowledging feelings

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Avoid

• Arguing
• Minimizing
• Challenging
• Giving false reassurance
• Interpreting or speculating on the dynamics of
  the clients problems

• Selling client on accepting treatment
• Probing sensitive areas
• Participating in criticism of any staff member
• Joining any attacks led by the client

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Attentive Listening Scale

• -THINGS TO AVOID
• Lack of eye contact
• Responding before the other finishes speaking
• Finishing other peoples sentences
• Talking so much that others cannot respond
• Continuing to work while someone is talking to
  you
• Repeat a point just made
• Allow your mind to wander during a conversation

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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 clients message
• clarification is summarizing the clients
  thoughts feelings resolving confusion

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Active Listening

• STOP TALKING
• demonstrate that you want to listen
• remove distractions
• be patient
• STOP TALKING

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Assertive Communication

• I Statements allow people to own (take
  responsibility for) their own thoughts feelings
• assertiveness involves taking a risk

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NONVERBAL CUES

• professional attire
• sit arms length away
• relaxed but attentive posture

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NONVERBAL CUES

• facial expressions and tone
• should be friendly interested
• use direct eye contact match your eye contact
  with the patients eye contact
• pay attention to body language of patient as well
  as your own body language

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Interviewing Techniques
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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

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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

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Progression ofthe 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

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Progression ofthe Interview

• Open-Ended Questions
• encourage the client to elaborate or give
  explanations (for example,
• What happened yesterday?)
• they provide direction keep the conversation
  focused

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Progression ofthe 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 todays date?

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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

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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?

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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

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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

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ConveyingUpsetting Information

• The SPIKES Model developed by Radziewicz Baile
  (2001)
• Setting
• Perception
• Invitation
• Knowledge emotions
• Summary

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Setting

• private comfortable
• invite others, such as family members

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Perception

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

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Invitation

• For example, the statement,
• Would you like me to explain more
• about what happened?

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Knowledge

• gradually dispense information assessing clients
  ability to cope with it
• The family may insist that the client not be told
  difficult news

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Emotions

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

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Summary

• review all important information with the client
  and family
• may need to repeat information more than once

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AVOID

• clichés
• poor listening
• closed questions
• intimidating how/why questions
• obvious probing questions
• advice
• leading questions (that suggest the response
• that you want)
• judgmental comments
• diverting
• false assurance

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COMMON ERRORS
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Blocks to Communication

• Failure to respect client
• Failure to listen
• Minimizing feelings
• Inappropriate comments questions
• Excessive questions
• Clichés
• Yes/no questions

• Probing
• Changing the subject
• Leading questions
• Advice
• Judgments
• False reassurance
• Giving approval/disapproval

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Self-Disclosure

• Use self disclosure to help clients open up
• to you not to meet your own needs
• Keep disclosures brief
• Dont imply that your experience is exactly the
  same as the clients
• Only self-disclose about situations that you have
  mastered

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Self-Disclosure

• Monitor your own comfort with
• self-disclosure
• Respect your clients needs for privacy
• Remember that there are cultural variations in
  the amount of self-disclosure considered
  appropriate
• Identify risks and benefits of self disclosure

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Therapeutic VersusNontherapeutic Communication

• THERAPEUTIC
• - Facilitates transformation of working
  nurse-patient relationship
• - Relationship allows for adequate accurate
  data collection assessment
• - Performed with not for patient

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Therapeutic VersusNontherapeutic Communication

• NONTHERAPEUTIC
• - Hinders relationship formation
• - Prevents patient from becoming mutual partner
  relegates him/her to passive recipient of care