Chapter 9

Therapeutic Communication

Patient-Centered

Refers to the patient as a full partner in care whose values, preferences and needs are respected

Transactional Model of Communication

• Communicatior: senders and receivers are both communicators, role is fluid

• Message: message is the content and the ideas that are being exchanged, relational, nonverbal, or verbal

• Channel: method of communication

• Feedback: messaging takes place with a constant feedback being give by both parties

• Encoding/Decoding: individuals encode (develop) messages and send to the other to decode (determine meaning) messages received from the other

• Context: frames and influences our interaction: social, relational, or cultural

• Environmental Noise: disturbs the message flow and can serve as a barrier: physical, physiological, psychological

Nonverbal Behaviors / Nonverbal communication

• Body behaviors: posture, movement, gestures, gait

• Facial expressions

• eye expression and gaze

• voice-related behaviors: tone, pitch, level, intensity, inflection, stuttering, pauses, silence, fluency

• Observable autonomic physiological responses: sweating, pupils, blushing, pale, breathing

• Personal appearance

• physical characteristics

Verbal Communication

• Consists of all the words a person speaks

• Main social symbols are words

Double-Bind Messages

• Characterized by two or more mutually ocntradictory messages given by a person in power

• Opting for either choice will result in displeasure of the person in power

Therapeutic Communication Techniques

• Skills that include words and actions that help to achieve health-related goals

• Ex. Silence, active listening, clarifiying techniques, questions, accepting, giving recognition, offering self, offering general leads, giving broad openings, placing the events in time/sequence, making observations, encouraging description of perception, encouraging comparison, giving information, presenting reality, vociing doubt, seeking consensual validation, verbalizing the implied, encouraging evaluation, attempt to translate feelings, collaboration, summarizing, formulate a plan,

Active Listenin

• Nurses focused on, respond and remember what the patient is saying verbally and non-verbally

• enhances self-esteem and encourage pt to deal with problems directly

Clarifying Techniques

• Nurse can request feedback on the accuracy of the message received to make sure they properly understand

• Ex. Paraphrasing, restating, reflecting, exploring,

Questions

• Open-Ended: encourages patients to share information about experience, perceptions or responses to a situation. Help the nurse obtain information. Useful in beginning of an interview

• Closed-Ended: gives you more specific and needed information.

• Projective: “what if'“; help people articulate, explore and ID thoughts and feelings or imagine thoughts, feelings and behaviors of a certain situation

Nontherapeutic Communication

• Tend to impede or shut down nurse-patient interactions

• Ex. excessive questioning, giving approval/disapproval, giving premature advice, minimizing feelings, false reassurance, making value judgments, asking “why” questions, changing the subject

Cultural Consideration

• Communication style

• use of eye contact

• perception of touch

• cultural filters

Cultural Filters

• form of cultural bias or prejudice

• determiens what we pay attention to and what we ignore

• provide structure for our lives and help us interpret and interact with the world

• unavoidalby introduce various forms of bias into our communication

Teleheath Technologies

• Video conferencing, the internet, phone consultation & counseling, image transmission, and interactive video sessions

• Issues with confidentiality, documentation, informed consent, record maintenance, and safety

Information Communication Technology

Valuable tool for consumers and practitoners to access current psychiatric and medical breakthroughs, diagnoses, and treatment options

Clinical Interview

• Preparing: Pace, setting, seating

• Introductions

• Tactics to Avoid: non-therapeutic approaches

• Behaviors to support counseling: therapeutic aproaches, kinesic communication, vocal quality, proxemics

• Debrief after

Proxemics

• Significance of the physical distance between individuals, concept of space

• Distances:

  • Intimate: less than & up to 18 inches, reserved for who we trust and feel safe with

  • Persoanl: 18 inches to 4 feet for personal communication with friends or colleagues

  • Social: 4-12 feet applies to strangers, acquaintances and often in public places or social gatherins

  • Public: 12+ feet, public space use for things like public speaking

• Most of the time with patients it is personal & social; enter intimate space for things like injections, vitals, meds, etc…

Debriefing

A critical converstaion and reflection regarding an experience that results in growth and learning