THERAPEUTIC COMMUNICATION Lecture objectives:

To understand communication as a nursing skill To distinguish between social and therapeutic communicationTo identify the goals of therapeutic communication To discuss the critical issues of therapeutic communicationTo identify and describe techniques that facilitate patient-centered therapeutic communicationTo identify common causes that interfere with therapeutic communication

THE GOALS OF COMMUNICATION IN PSYCHIATRIC NURSING

To understand the patient To ensure that the patient understands the

nurse To teach the patient how to communicate

more effectively in order to interact with society in a meaningful way and get there needs met

Therapeutic communication

Interactive verbal and non-verbal strategies that focus on the needs of patients and facilitate a goal-directed, patient-oriented communication process. Therapeutic communication is often time limited.

Therapeutic listening

Listening that is focused on patients and obtains therapeutically useful information about patients.

TYPES OF COMMUNICATION

Verbal

Environment

Nonverbal

Electronic

CONTENT AND PROCESS

Content: the explicit words spoken, the substantive issues, the “what”.. The overt meaning of the communication.

Process: a process-oriented focus is concerned with the “how” or “why” verbal content is communicated, or the covert meaning.

METACOMMUNICATION: the communication about communication, a message about the nature of the relationship between the two interacting individuals.

METACOMMUNICATION: the communication about communication, a message about the nature of the relationship between the two interacting individuals.

“close the window!”

“wouldn’t you like to close the window? You must be cold.”

“I’m cold, would you please close the window?”

“Why is this window open?”

Factors that influence communication

Gender Culture Personal/life experiences Feelings Beliefs Attitudes Self-concept Socioeconomic status

THE ROLE OF SELF-AWARENESS

“Know thyself” (Boyd, 2002)

Self awareness is the process of understanding one’s own beliefs, thoughts,

motivations, biases, and limitations and recognizing how they affect others.

Therapeutic Social communication

Purpose To meet the needs of the patient.

Personal enjoyment of both parties, both parties seek to get personal needs met.

ContentPlanned and directed by the professional to meet patient needs. Important for professional to maintain objective professional distance

Both parties may share emotional and personal information.

Expectations Sharing information is on a need-to-know basis with other professional team members.

If parties are friends, shared feelings and emotional material are assumed to be confidential.

THERAPEUTIC USE OF SELF

Sensitivity … to recognize important cues and make decisions about the priority of the cues.

Objectivity …openness to patients, problems, and solutions; must be aware of own reactions and bias’

Empathy … objectively recognize, understand and communicate patients’ feelings to patient ; “communicating understanding”

Therapeutic techniques Description Offering self Active listening Silence Empathy Questioning General leads Restating Verbalizing the implied ClarificationAnalysis & Conclusions Making observations Presenting reality Encouraging description of

perceptions Voicing doubt Placing an event in time or

sequence Encouraging comparisons

Identifying themes SummarizingProblem solving & Decisions Suggesting collaboration Encourage goal setting Providing information Encouraging decisions and

consideration of options Formulating planCompletion of plans Testing out new behaviors Supportive confrontation Limit setting FeedbackEvaluation Encouraging evaluation Reinforcement

BARRIERS TO EFFECTIVE COMMUNICATION

Factors related to the RN

Factors related to the client

WHAT TO AVOID

avoid excessive questions

avoid giving advice

avoid giving false reassurance

avoid requesting and explanation avoid giving approval

APPLICABLE NURSING DIAGNOSIS

Impaired Social Interaction (insufficient or excessive quantity or ineffective quality of social interaction)

Impaired Verbal Communication (decreased, delay, or absent ability to receive, process, transmit and use a system of symbols)

Nursing intervention (depends on the etiology and manifestation)

Case scenarios……

During a one-to-one interaction with the nurse, a patient frequently looks nervously at the door. What might your response be? What therapeutic technique is this?

Case scenarios……

During a one-to-one interaction with the nurse, a patient frequently looks nervously at the door. What might your response be? What therapeutic technique is this?

A patient has been withdrawn and suspicious since admission. He is wary of staff and other patients. An example of appropriate use of touch with this patient is……

Case scenarios……

During a one-to-one interaction with the nurse, a patient frequently looks nervously at the door. What might your response be? What therapeutic technique is this?

A patient has been withdrawn and suspicious since admission. He is wary of staff and other patients. An example of appropriate use of touch with this patient is……

The nurse tells a patient, “I noticed that you seemed to become irritated when we discussed your relationship with your husband.” The nurse is using the communication technique known as:

Case scenarios……

During a one-to-one interaction with the nurse, a patient frequently looks nervously at the door. What might your response be? What therapeutic technique is this?

A patient has been withdrawn and suspicious since admission. He is wary of staff and other patients. An example of appropriate use of touch with this patient is……

The nurse tells a patient, “I noticed that you seemed to become irritated when we discussed your relationship with your husband.” The nurse is using the communication technique known as…

You realize you have just made an insensitive remark to a patient. How might you respond to the patient in a therapeutic manner?

Case scenarios……

A patient who is scheduled to attend a number of treatment groups becomes angry and complains, “I’m really ticked about having to attend all those groups. No one else spends all day in a circle in a little tiny room.” How might you respond to this patient? What therapeutic technique are you using?

NURSE-PATIENT RELATIONSHIP

Objectives:

To identify goals of the nurse-patient relationship

To identify and discuss the stages of the nurse-patient relationship

To identify the major tasks in each stage of the nurse-patient relationship

Goals of the therapeutic nurse-client relationships:

• to enhance client well-being• to promote recovery• to support the self-care functioning of

the client

NURSE-PATIENT RELATIONSHIP

Stages of the nurse-patient relationship

*planned, patient centered and goal directed*

Stage I: Pre-Orientation Stage II: Orientation Stage III:Working Stage Stage IV: Termination

NURSE-PATIENT RELATIONSHIP

Stages of the nurse-patient relationship

*planned, patient centered and goal directed*

Stage I: Pre-Orientation Stage II: Orientation Stage III:Working Stage Stage IV: Termination

INTERACTIONS WITH SELECTED BEHAVIOR

Violent behavior Hallucinations Delusions Conflicting values Incoherent speech patterns Manipulation Crying Sexual advances/inappropriate touch Denial and lack of cooperation Depressed affect Suspicious hyperactivity

Transferenceoccurs when a client takes the perceptions and expectations of one person and projects them onto another person (usually the care provider)

Countertransferenceoccurs when a nurse or care provider takes the perceptions and expectations of one person and projects them onto another person

Transferenceoccurs when a client takes the perceptions and expectations of one person and projects them onto another person (usually the care provider)

Countertransferenceoccurs when a nurse or care provider takes the perceptions and expectations of one person and projects them onto another person

case scenarios…. John S. is suspicious, denying his illness, and hyperactive.

What combination of nursing interventions would you use in working with him? Does it matter what stage your nurse-patient

relationship is?

A patient is admitted to an inpatient psychiatric unit for severe depression. Knowing that the patient will be discharged after a short stay what might be your main goals… how does this affect how you move through the stages of the therapeutic relationship?

A 27-year old patient with schizophrenia says to the nurse, “I feel really close to you. You’re the only true friend I have.” The most therapeutic response for the nurse to make is:

case scenarios…. A fellow nursing student says to you: “I can’t get used to

doing things like playing cards or having a unit party. They don’t seem like a worthwhile use of nursing time.” How might you respond to your peer?

Describe a strategy that would be useful when the nurse finds that his/her values and the patient’s values are in conflict.