NCM 103 Unit 5. Therapeutic Communication

Communication

the process of transmitting thoughts, feelings, facts, and other information. includes verbal and non-verbal behavior

Communication

in Nursing, it is the vehicle for establishing a therapeutic relationship with a client

Communication

process that requires interpretation, sensitivity, imagination, and active participation

Babbling

making sounds

Holophrastic

one word for all objects

Semantics

relations between words and meaning

Grammar

rules for language usage

Words

symbols that represent objects themselves

Characteristics of Words

* abstract: ideas (love, freedom)
* concrete: person, place, thing (friend, school, car)
* denotative vs connotative

Denotative

The dictionary meaning of words

Connotative

the individuals emotional or personal response to a word

Slang

informal, non-standard vocabulary

Jargon

vocabulary that relates to specific subject

Regionalisms

Vocabulary that relates to a particular
area or region.

Cultural Terms

Vocabulary that relates to the particular
background of people.

Verbal Strategies

Use a set of words chosen to have a
specific effect on another person.
Exclude/include, reveal/conceal

Components of the Communication Process

* sender
* the message
* channel

1. Visual channel – sight, observation, and perception
2. Auditory channel – consists of spoken words and cues.
3. Kinesthetic channel – refers to experiencing

3 major communication channels

Sender

A person who generates a message. It stem from a person’s need to relate to others, to create meanings, and to understand various situations

The Message

Stimulus produced by a sender and responded to by a receiver. May be verbal, non-verbal, written materials, and arts

The Channel

* medium through which a message is transmitted. each person has a dominant channel that influences communication

Receiver

Is the person who intercepts the senders message. Receiving is influenced by complex physiological, psychological, and cognitive process.

Feedback

Is the information the sender receives about the receivers reaction to the message. Its function is to provide the sender with information about the receivers perception of a situation.

The Feedback

* Is the information the sender receives about the receivers reaction to the message.
* function of feedback is to provide the sender with information about the receivers perception of a situation.

intonation

can express enthusiasm, sadness, anger, or amusement.

pace of speech

may indicate interest, anxiety, boredom, or fear

Simplicity

It includes the use of commonly understood words, brevity, and completeness.

Adaptability

* Spoken messages need to be altered in accordance with behavioral cues from the client.
* What the nurse says and how it is said must be individualized and carefully considered. This requires astute assessment and sensitivity on the part of the nurse.

Credibility

it means worthiness of belief, trustworthiness, and reliability.

Humor

* can be positive and powerful tool in the nurse-client relationship, BUT it must be use with care.
* can be used to help clients adjust to difficult and painful situations but it may be considered offensive or distracting at a peak crisis period.

NON-VERBAL COMMUNICATION

* Sometimes called body language.
* includes gestures, body movements, use of touch, and physical appearance, including adornment.
* often tells others more about what a person is feeling that what actually said; because it is controlled less consciously than verbal behavior.

□ DEVELOPMENT
□ GENDER
□ VALUES AND PERCEPTIONS
□ PERSONAL SPACE
□ TERRITORIALITY
□ ROLES AND RELATIONSHIPS
□ ENVIRONMENT
□ CONGRUENCE, AND
□ ATTITUDES

FACTORS INFLUENCING COMMUNICATION PROCESS

Values

– are the standards that influence behavior.

Perceptions

– are the personal view of an event.

PERSONAL SPACE

□ Is the distance people prefer in interactions with others.

PROXEMICS

is the study of distance between people in their interactions.

TERRITORIALITY

□ Is a concept of the space and things that an individual considers as belonging to the self.

ELDERSPEAK

is a speech style similar to baby talk, that gives the message of dependence and incompetence to older adults. It does not communicate respect.

* Intimate Distance
* Personal Distance
* Social or Public Distance

Types of Personal Space

Intimate Distance

* Reserved for people who feel vision is affected in that it is restricted to one portion of the other’s body; may be distorted; tone of voice may seem louder; body smells noticeable; increased sensation of body heat.
* Nurse often must intrude on this space
* Explain intention to client.
* Respect client’s space as much as possible. May be used for comforting and protecting.

Personal Distance

* Usually maintained with friends. Vision is clear since more of the other person is visible. Tone of voice is moderate. Sensations of body heat and smells are lessened.
* Better able to read non-verbal communication at the distance.

Social or Public Distance

Generally used when conducting impersonal business. Communication is more formal and less intense. Sensory involvement is less intense. Increased eye contact.

CHRONEMICS

is the study of the effects of time on the communication process. The amount of time spent in communicating depends on the client’s needs. The whole communication process is affected by time.

* Intra-personal Level
* Inter-personal Level
* Group Communication Level

LEVELS OF COMMUNICATION

INTRA-PERSONAL LEVEL

is the message sent to oneself including self-talk or communication with oneself. A person receiving internal or external messages organizes, interprets, and assigns meaning to the messages. Self-talk is based on personal background, experiences, personal needs, defenses, culture, education, developmental level

INTER-PERSONAL LEVEL

Is the process that occurs between two people either in face-to-face encounters, over the telephone or other through communication media.

GROUP COMMUNICATION LEVEL

* Occurs when 3 or more people meet in face-to-face encounters or through another communication medium, such as conference call.
* This level of communication is complex because of both the number of people communicating intra-personally and inter-personally and the combinations of the people involved.

Group Dynamics.

The study of the events that take place during group interaction. This can influence that productivity of the group.

Small Group Ecology

□ The study of proxemics (effect that space has on communication) in small group situations and provides a potent source of non-verbal messages about participants.

Cohesiveness

– bonding among group members with a common purpose or goal.

* Communication
* Critical thinking
* Collaboration

3 Mechanisms Used by Nurses to Connect Clients
W/ Health Promoting Groups

Communication

– the nurse actively listens to the client to determine needs.

Critical thinking

– the nurse uses cognitive processes to decide which groups are congruent with the client needs.

Collaboration

– the nurse works with multi-disciplinary team members (i.e. social workers, clergy) to start the referral process.

* Task group
* Therapeutic group
* Therapy group
* Self-help group

Types of Groups

Task Group

* Focuses on achievement of a specific goal. Emphasizes problem-solving and decision making.
* EX: Diabetes education group. Committee to study staffing issues. Student Nurses Association

Therapeutic Groups

* Increases members coping abilities. Offers support. Provides education and information.
* EX:

Stress Mgt. Class
Bereavement and Grieving
Exercise Group

Therapy Groups

* Helps members learn about and change problematic behaviors. Focuses on emotional and behavioral disorders.
* EX:

Psychotherapy
group
Cognitive
Behavioral
Group

Self-help groups

* Focuses on a common experience of all members often led by non-professional
* EX:

Weight Watcher

Alcoholic anonymouss

Verbal Messages

* Are messages communicated through words and language, either spoken or written.
* They are accompanied by para-verbal cues (paralinguistic): tone and pitch of voice, speed, inflection, and volume, grunts and other non-language vocalizations.

Non-Verbal Messages

Unspoken messages often carry more weight than verbal and para-verbal ones, and they can be more reliable. These are messages communicated without words; that is through body language.

* Facial expression
* Posture
* Gestures
* Touch

Major non-verbal aspects of communication:

Facial expression

– gives clues that support, contradict, or disguise the verbal message. It serves as clues to emotionally charged topics and often communicate the client’s need.

Gestures

– refers to the movement of body parts.

Touch

– can communicate a sense of caring– as it does when a nurse holds a persons hand during a painful procedure – or it can be perceived as intrusive or hostile touch should be used cautiously with clients who are confused, aggressive, suspicious.

* SOCIAL ZONE
* CONSENT ZONE
* VULNERABLE ZONE
* NTIMATE ZONE

ZONES OF TOUCH

Social Zone

(permission not needed) hands, arms, shoulder, back

CONSENT ZONE

(permission needed) mouth, wrists, feet

VULNERABLE ZONE

(special care needed) face, neck, front of body

INTIMATE ZONE

(great sensitivity needed) genitalia

Physical Appearance and Artifacts

– convey non-verbal messages
that enhance or hinder the
spoken words.
(It includes items in clients
environment, grooming, or use of
clothing and jewelry).

Metacommunication

* Is the relationship aspect of communication. It refers to the message about the message and to all the factors that influence how messages are received.

* PRE-INTERACTION
* ORIENTATION
* WORKING PHASE
* TERMINATION PHASE

Phases of the Helping Relationship

PRE-INTERACTION

– before meeting the client the nurse

ORIENTATION

– when the nurse and client meet and get to know one another

WORKING PHASE 2

– when the nurse and client work together to solve problems and accomplish goals

TERMINATION PHASE

– during the ending of the relationship

PRE-INTERACTION PHASE

The nurse:

* Reviews available data
* Talks to other caregivers
* Anticipates health concerns or issues
* Identifies a location and setting that will foster comfortable private interaction
* Plans enough time for the initial interaction

ORIENTATION PHASE

The nurse;

* Sets the tone for the rel’ship by adopting a warm, emphatic, caring manner
* Recognizes that the initial rel’ships may be superficial, uncertain, and tentative
* Expects the client to test the nurse competence and commitment
* Assess the clients health status Forms contracts with the client

WORKING PHASE

The nurse;

* Encourages and helps the client to express feelings about his health
* Encourages and helps the client with self-exploration, set goals
* Uses therapeutic communication skills to facilitate successful interactions
* Uses appropriate self-disclosure and confrontation

TERMINATION PHASE

□ The nurse;

* Reminds the client that termination is near
* Evaluates goal achievement with the client
* Achieves a smooth transition for the client to other caregivers as needed

* Interdisciplinary Communication
* Therapeutic Communication

TYPES OF COMMUNICATION

INTERDISCIPLINARY COMMUNICATION

It involves communication (assessment, intervention outcomes, and client status) between the health team members.

THERAPEUTIC COMMUNICATION

* Is the use of communication for the purpose of creating a beneficial outcome for the client or improve the clients ability to function.
* It facilitates the establishment of the nurse-patient relationship and fulfills the purposes of nursing.

1. Is purposeful and goal directed
2. Has well-defined boundaries
3. Is client-focused
4. Is non-judgmental
5. Uses well-planned, selected
techniques

THERAPEUTIC COMMUNICATION Characteristics:

□ Encourage self disclosure

□ Increase feelings of selfworth

□ Promote increased understanding (insight)

□ Encourage problem solving

□ Facilitate decision making

Goals of therapeutic communication

EMPATHY

An emotional linkage between 2 or more people through w/c feelings are communicated. Involves trying to imagine what it must be like to be in another persons situation.

TRUST

The clients belief that the nurse will behave predictably and competently while respecting the clients needs.

Honesty

The ability to be truthful, frank and sincere.

VALIDATION

Listening to the client and responding congruently in order to be sure that the nurse and client have the same understanding of a problem or issue.

CARING

The level of emotional Involvement between the nurse and the client.

ACTIVE LISTENING

Hearing and interpreting language, noticing non-verbal and para-verbal enhancements and identifying underlying feelings.

Principles of Therapeutic Interaction

1. Plan to interview at an appropriate time.
2. Assure privacy.
3. Establish guidelines for the therapeutic
interaction.
4. Provide for comfort during the interaction.
5. Accept the client exactly as is.
6. Encourage spontaneity.
7. Focus on the client and on the lead and clues
presented.
8. Encourage the expression of feelings.
9. Be aware of your own feelings and during the
interaction.

Offering self

Therapeutic Communication Technique Example:

“I’ll sit with you a while.”
“Go on.” “Uh-uh.”
Head nodding.

Broad openings

Therapeutic Communication Technique Example:

“What do you want to talk
about?”
Can you tell me more about
that?
How have things been going ?

Silence

Therapeutic Communication Technique Example:

* Sit quietly and observe clients behavior.
* Use appropriate eye contact.
* Employ attending behaviors.
* Control own discomfort during quiet periods or conversation lulls.

* OPEN-ENDED COMMENTS
* REFLECTION
* RESTATING

TECHNIQUES THAT ENCOURAGE SPONTANEITY

Open-ended Comments

Therapeutic Communication Technique Example:

* “Tell me about your pain? Instead ‘Are you in pain?’
* “Tell me about your family”, rather than “How many children do you have.”

REFLECTION

Therapeutic Communication Technique Example:

Client: “Do you think I should tell the doctor I stopped taking my medication?”

Nurse: “What do you think about that?

Client: “I probably should but the medicine makes me so tearful and agitated.”

Nurse: “You should a bit agitated now.”

RESTATING

Therapeutic Communication Technique Example:

Client: “I told the doctor that I had problems with this medicine, but he just didn’t listen to me.”

Nurse: “Sounds like you’re pretty angry at him.”

Client: “I don’t sleep well anymore.”

Nurse: “You’re having problems sleeping?”