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Communictation
  • Exchange of information
  • Verbal: content (literal words spoken), context (enviroment, circumstances, situation in which communication occurs)
  • Nonerbal: behaviors, body language, distance, tone, rate, volume
Nonverbal behavior
  • Show the process
  • all messages used to give meaning to the message
  • sometimes communication is not congruent (verbal/nonverbal do not match)
  • nonverbal is more important than nonverbal
Therapeutic Communication
  • A component of the nurse-pt relationship
  • interpersonal interactions where you utilize (therapeutic use of self)
  • Working phase: set the stage for interaction, you actively listen focusing entirely on the pt, you wrap it up and bring it to a smooth end
Goals
  • Establish a therapeutic relationship
  • Identify clients most important concerns
  • Assess clients perspectives
  • Fscilitate client's expression of emotions
  • Teach client and family self-care skills
  • Recognize client's needs and implement interventions to address those needs
  • guide the client toward acceptable solutions
Emphasis in this course
  • Focus on active listening and active observation
  • put your own thoughts aside and try to avoid thinking about what you will say next
  • help the pt sort out their feelings
  • help the pt identify what is important to them at this time
Be aware
  • You do not have the power to render them irreparable harm
  • you will be clumsy in listening at times
  • Eg: changing the subject, avoiding the use of silence, seeking the why/root of their problem
Physical Boundaries
  • Respect boundaries
  • Distance zones:
  • Intimate (0-18 inches)
  • Personal (18-36 inches)
  • Social (4-12 feet)
  • Public (12-25 feet)
  • Therapeutic communication is most comfortable when nurse and client are 3-6 feet apart
Touch
  • 5 types: functional/professional, social-polite, friendship-warmth, love-intimacy, sexual-arousal
  • Comforting and supportive, also possible invasion of intimate and personal space
  • We will not touch patients in this setting
  • pts can be paranoid
  • they can misinterret their enviroment
  • they can experience it as a threat
Cultural Issues
  • eye contact
  • touching
  • distance
Setting the stage
  • meet in a public area
  • if you are directed to use a conference room, keep the door open and sit near the door
  • the pt should not be between you and the door
  • let people know where you are and for how long
Setting the stage cont.
  • sit across a table, or more than three feet apart
  • put your chairs so that you face the pt, but not directly
  • keep open body language
Verbal communication skills
  • Need for concrete, not abstract messages
  • Concrete: be clear and specific, use words that cannot express more than one meaning, avoid joking and sarcasm (incongruent)
  • Abstract: being vague, using slang, making general statements
Therapeutic Techniques
  • Exploring
  • Restating
  • Reflecting promotes discussion of feelings or concerns in more depth
  • other techniques useful in focusing or clarifying what is being said
  • feedback via making an observation or presenting reality
  • compare to non-therapeutic techniques
Active observation
  • Interpretation of signals and cues
  • Overt: obvious, clear
  • Covert: vague, unclear, may require further assessment, observation and clarification.
  • Identify a central topic (theme they keep coming back to (they will do this even if you change the subject)
  • clarify metaphors
  • clarify proverbs or cliches
  • you can ask directly what the mean, especially about safety
nonverbal communication skills
  • Facial expression: expressive, impassive, confusing
  • Body language: open, closed, vocal ues, eye contact, silence
Cultural Considerations
  • need for awareness of cultural differences
  • speech patterns, habits
  • styles of speech, expression
  • eye contact
  • touch
  • concept of time
  • health, health care
Therapeutic Communication session Goals
  • establishing rapport
  • identifying issues of concern
  • being empathetic, geenuine, caring, unconditionally accepting of the person
  • understanding the client's perception
  • exploring the client's thoughts, feelings
  • developing problem-solving skills
  • promoting client's evaluation of solutions
Therapeutic communication: initiating the session
  • introduction
  • establishment of contract for relationship
  • identification of major concern
  • nondirective role (broad opening, open ended questions)
  • directive role (direct questions) usually for suicidal, crisis, manic, pts
Proper phrasing of questions
  • Clarification
  • identification of client's avoidance of an anxiety producing topic
  • guidance in problem solving, empowerment to change
Self-Awareness issues
  • nonverbal communication is as important as verbal communication
  • therapeutic communication influential in effectiveness of interventions
  • awareness of own communication is first step in improving communication
  • ask for feedback from colleagues
  • examine own communication skills
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