Therapeutic Communication

The nurse lust be aware of the therapeutic or non therapeutic value of the communication
techniques used with the client they are the tools of psychosocial interventions.

Attentive listening
-Listening attentively, using all sensens
-Probably the most important techniques in nursing and is basic to all other techniques
-Absorbing both the content and the feeling the person in conveying, without selectively
-Involves listening for key themes

Physical attending
Five aspects of physical attending
S - sit squarely facing the client
O - observe an open posture
L - lean forward toward the client
E - establish eye contact
R - relax

Techniques of Therapeutic Communication

Using Silence
Accepting pauses or silent that may extend for several seconds or minutes without interjecting
any verbal responses
- sitting quietly/ walking with the client

Providing General Leads

Using statements or questions that:
a) encourage the client to verbalize
b) choose a topic of conversation
c) faculitate continued verbalization
" Then what?"...
" Please go on."
" Where would you like to begin?"

Using Touch
Providing appropriate forms if touch to reinforce caring feelings

Restating
Actively listening for the clients basic message and then repeating those thoughts and/or
feelings in similar words
Repeating the main idea expressed by the client saying the same key words that he has just
spoken
C: " My life is full of pain."
N: " Your life has been full of pain?"
Paraphrasing
- used by the nurse to rephrase a client's comment or question in a manner that is similar to
what the nurse thinks thst they have heard and understood.
- stating in newer and fewer words the basic content of the client's message
" In other words, you seem to be saying..."

Seeking Clarification
Making the clients broad overall meaning of the message more understable
Used when paraphrasing is difficult or when the communication is rambling or garbled
" Would you please say that again?"
" Let me repeat to you what I think I heard you say. "

Offering self
Suggesting ones presence, interest, or wish to understand the client without making any
demands
" I'll help you dress to go home, if you like."
" Let me sit woth you for 15 minutes and read a story."
" I'll stay with you until your daughter arrives."
" I'll sit with you for a while."

Giving Information
Providing in a simple and direct manner, specific factual information the client may or may not
request
" Your CBC test is scheduled tomorrow at 5 o clock in the morning.

Clarifying time or sequence

Helping the client clarify an event, situation or happening in relationship to time
" Were you frightened before or after the movie?"
" What happened befor?"
"When did this happen?"

Presenting reality
Helping the client to differentiate the real from the unreal
" Your magazine is here in the drawer. It has not been stolen.
C: " Did you bring my car?"
N: No, you dont have a car. I drove my car here today."

Reflecting
Directing ideas, feelings , questions, or content back to clients to enable them to explore their
own ideas and feelings about a situation
C: " My brother spends all my money and then has the nerve to ask for more."
N: This causes you to feel angry?"
Summarizing
Stating the main points of a. Discussion to clarify the relevant points discussed
Useful at the end of an interview or to interview health teaching session
" During the oast 39 minutes, you and I hsve discussed..."
" Let's see, so far you have said.."

Exploring
Examining imprtant ideas, experiences , or relationships more fully
C: I do not get along well with my wife."
N: Give me example of you and your wife not getting along."
C: I feel healthy today "
N: tell me more about how healthy you are

Encouring formulation of a plan of action

Identifying alternative sections for interpersonal situations
" Next time this comes up, what might you do to handle it?"
" What colud you do to improve the weight of your child?"
" What will it take your goal of not hitting anyone?"

Giving broad openings

Clarifies that the lead is taken by the client
" Where would you like to begin?"
"" What are you thinking about?"
" What would you like to discuss today?"

Notes in Therapeutic Communication Techniques

• Best responses are those that:
- encourage clinets to express more fully
- reflects or re- states what the client has earlier said
- reflects the feeling that are indentified and encourage expression of these feelings
- encourage hope( never with false assurance)
- clarifies clients statement
- acknowledges clients nonverbal behavior
- uses silence but expresses being there
- informs
-clarifies and validates

Remember to:
Focus on the client
Accept clients as he/she is
Be honest and consistent
Attempt to establish goods relationship
Allow clients then family to make decision
Answer according to nursing action
• Do not provide responses that implies thst the client is unworthy
• Select the most comprehensive answer
• Focus on the feeling of client

Barriers to Communication
• Need ro be recognized when they occur
• Major barriers
• Failure to listen

Poor choice of words

Wrong environment or poor environmental control- noisy surrounding or environment
Wrong timing- while or when client is eating or doing something or in pain
Inconsideration- by the nurse or health professional- client is eating or sleeping, with nurse not
willing or ready to wait

The Helping Relationship

• Referred to as
•Interpersonal relationships
• Therapeutic relationships.
Three basic goals for helping clients
• Manage problems in living more effectively
• Become better at helping themselves in their everyday lives
• Develop action- oriented prevention mentality in their lives

• Factors influencing helping relationships

• Age, sex
• Appearance
• Diagnosis
• Education
• Values
• Ethnic and cultural background
• Personality
• Expectations
• Setting

Phases of the Helping Relationship

• Preinteraction phase
• Obtain information before first faceto face meeting
• Names address, age, medical history, and/ or social history
• Anxious feelings in nurse addressed by identifying specific information to be discussed
• Introductory phase
### MUST
Orientation phase
• Sets tone for the rest of the relationship
• Develop trust and security
• Getting to know each other
• Resistive behaviors nay be displayed.
Inhibit

Working phase
•View each ither as unique individuals
•Once caring develoos, empathy increases.
•Exploring and understanding thoughts and feelings
•Facilitating and taking action
• Helping client explore thoughtsz feelings, and actions

Termination phase
•Nurse and client accept feelings of loss
•Client accepts the end of the relationship without feelings of anxiety or dependence

Developing Helping Relationship

• Listen actively
•Help to identify feelings
•Out yourself in others shoes
•Be honest genuine and credible
•Use ingenuity
•Be ware of cultural differences
•Maintain confidentiality
Know your role and limitations

Think before you talk ...and do not talk all what you think...

Process Recording
A verbatim account of a conversation
The technique by which we record the verbal interaction