Chapter 7 Therapeutic Communication

The nurse provides the pt with the opportunity to (3):

1. Identify and explore problems in relating to others

2. Discover healthy ways of meeting emotional needs

3. Experience a satisfying interpersonal relationship

Interpersonal communication is a:

Transaction between the sender and the receiver. Both persons participate simultaneously.

Preexisting condictions

Values, attitudes, and beliefs

Culture and religion

Social status

Gender

Age or developmental level

Environment of transaction

Values, attitudes, and beliefs

Learned ways of thinking

Can influence communication in numerous ways

Culture or religion

Cultural mores (rules/infringements), norms, ideas, and customs provide the basis for ways of thinking

Social status

High status persons often convey their high power position with gestures (Hands on hips, power dressing, greater height, and more distance when communicating with “lower” individuals.

Gender

Masculine and feminine gestures influence messages conveyed in communication with others

Age or developmental level

For example, the influence of developmental level on communication is especially evident during adolescence.

Environment of the transaction

Territoriality is the innate tendency to own space

Density refers to the number of people within a given space

Distance is the means by which various cultures use space to communicate

Nonverbal communication

1. Physical appearance and dress

2. Body movement and posture

3. Touch

4. Facial expressions

5. Eye behavior

6. Vocal cues (as an add on) or paralanguage (around langue, includes body and noises)

Therapeutic communication includes caregiver _______ and _______ techniques

Verbal and nonverbal

Therapeutic communication encourages:

Exploration of feelings and fosters understanding of behavioral motivations.

Therapeutic communication is ______, discourages ________, and promotes ________

Nonjudgemental (be self aware);defensiveness: trust

Therapeutic communication techniques (19):

1. Using silence

2. Accepting

3. Giving recognition/approval

4. Offering self

5. Giving broad openings (open-ended questions)

6. Offering general leads (leading the conversation/continuing it)

7. Placing the event in time sequence (to show understanding)

8. Encouraging description of perceptions

9. Encouraging comparison

10. Restating

11. Reflecting

12. Focusing

13. Exploring (helping not deciding in pt’s place)

14. Seeking clarification and validation

15. Presenting reality

16. Voicing doubt (dont be too blunt)

17. Verbalizing the implied

18. Attempting to translate words into feelings

19. Formulating a plan of action

No therapeutic communication techniques (13):

1. Giving false reassurance

2. Rejecting

3. Approving or disapproving

4. Agreeing or disagreeing

5. Giving advice

6. Probing

7. Defending

8. Requesting an explanation

9. Belittling feelings

10. Making stereotyped comments

11. Using denial

12. Interpreting

13. Introducing an unrelated topic

Active listening

Is to be attentive to what the pt is saying, both verbally and nonverbally.

Several nonverbal behaviors have been designed to facilitate attentive listening.

Active listening SOLER:

S: sit squarely facing the pt

O: observe an open posture

L: lean forward toward the pt

E: establish eye contact

R: relax

Motivational Interviewing

An evidence-based, patient-centered style of communicating that promotes behavior change by guiding the pt to explore their own motivation for change and the advantages and disadvantages of their decisions.

Feedback

Be descriptive rather than evaluative and focused on the behavior rather than on the pt

Be specific rather than general

Should be directed toward behavior the pt has the capacity to modify

Imparts information rather than offers advice

Make sure it is well timed