THERAPEUTIC COMMUNICATION
Prepared by: Joseph Alvin C. Paulino, RN., MAN. Faculty of Nursing Bulacan State University
Therapeutic Communication
Is an interactive process that occurs between the
patient and the health professional;
Focuses solely on the patients problem; Establishment of trust as a foundation is very
important in a nurse-patient relationship;
Is to elicit information about the patients needs,
feelings, and ideas so the nurse can understand the patients problems and develop interventions that will strengthen his insight and self-control;
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Difference between Social and Therapeutic Communication
Social Communication Therapeutic Communication
Focuses on mutual sharing; Promotes mutual pleasure; Has no time limit; No contract involve; Doesnt require the Focuses on the patient; Promotes patients healing; It is time limited; Involves a contract between
participants to examine their behavior OR to possess a specialized knowledge base.
the nurse and the patient; The nurse must have profound knowledge and understanding of the NursePatient Relationship.
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Principles of Therapeutic Communication
1. Genuineness
Nurse must display sincere interest using consistent words and actions; This promotes openness, self-acceptance, and personal freedom of the patient.
2. Respect
Nurse must have an unconditional positive regard for the patient; Non-judgemental acceptence of the patients ideas and beliefs.
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3. Honesty
A consistent, open, and frank, approach promotes
authenticity in the NPR; Makes the patient trust the nurse.
4. Concreteness
Nurse should use clear, specific, and concrete
language rather than abstraction.
5. Assisstance
Nurse must exhibit a wiling commitment and will stay
with the patient; By staying with the patient, the nurse have something of value to offer the patient.
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6. Protection
Patient must feel safe from threat and confrontations.
7. Permission
Patient must feel free to explore new ways on dealing
with past problems in order to built autonomy; Patients learning to try alternative behaviors is central to eliminating the patients problems.
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Techniques in Therapeutic Communication
1. Listening
Focusing intently on what the patient is telling you.
2. Restating
Rephrasing helps ensure the nurses understanding and emphasizes important points in the patients statements; You said that you wanted to hurt yourself?
3. Using broad openings
General statements or questions that begin with WHAT, WHEN, WHERE and HOW to initiate a conversation.
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4. Clarifying
Attempting to put a patients confusing or vague
message into words or asking the patient what she or he means; I dont think I understand what you are saying.
5. Confrontation
Calls attention to discrepancies the nurse perceives in
patients communication patterns.
6. Focusing
Keeps the communication goal-oriented and foster the
patients self-control and helps avoid vague generalization.
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7. Suggesting
Presenting alternatives for the patient to consider; Gives the patient the opportunity to explore the
advantages and disadvantages of numerous choices; Avoid directing the patient.
8. Sharing perceptions
The nurse describes his or her understanding of the
patients feelings and then seeks corrective feedback from the patient.
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9. Identifying themes The nurse states the experience, issues, or problems the patients discloses repeatedly during the interaction. 10. Reflecting The nurse repeats the patients ideas, feelings, questions, or content; It imparts interest, empathy and respect for the patient.
11. Silence. 12. Showing empathy.
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13. Validating
Checking perception of clients statements.
14. Summarizing
Putting together salient points of a previous interaction.
15. Offering self
Providing support and comfort to the client by staying
with the client.
16. Presenting reality
Reporting events as they really exists.
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Blocks to Constructive Communication
(These are methods of communication that obstruct the process of therapeutic communcation. (Non-therapeutic))
1. Giving personal advice Feelings can be disturbing.
2. Providing false reassurance Giving patient false hopes and false information. 3. Asking WHY questions (dont hesitate always wrong!!!)
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4. Using emotionally charges language This may reinforce the patients symptoms
5. Straying from patients agenda Altered focus will send information to the patient that the nurse is not interested in the communication 6. Delivering double message The patient will find it difficult to understand the meaning of the message 7. Rejecting clients statements 8. Agreeing and disagreeing with the client
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Therapeutic Relationship
Is a relationship by the nurse and the client that
is directed towards enhancing the clients wellbeing.
Elements of a Therapeutic Relationship 1.
Contract
The nurse must establish the time, place, and purpose of every meetings as well as the conditions for terminating the meetings.
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2. Boundaries
The roles of the participants are clearly defined and
observed The clients needs and concerns are the focus of the interaction
3. Confidentiality
Basic condition of the interaction and needs to be
observed by the nurse The nurse shares client information only with a professional staff that needs to know the interactions The nurse must obtain the consent of the patient if an information must be shared to others outside the treatment team.
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4. Therapeutic nurse behaviors
Genuine and warm behaviors Respectful Empathy Exhibit cultural sensitivity
Collaborative goal setting
Self-awareness
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Phases of Therapeutic Relationship
A. Orientation
Assessment or analysis stage The patient feels in need and will seek help The nurse establishes trust with the client Establishment of contract The nurse assesses the client Formulation of diagnosis Prioritization of the clients problems The nurse and the client establish mutually agreed goals Preparation for termination begins
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B. Working Phase
Or the identification and exploration stage The nurse plans outcomes and related interventions to
assist client to meet goals The nurse facilitates the clients expression of problems, thoughts, and feelings The nurse uses problem-solving approach The nurse encourages and teaches coping measures The nurse encourages the client to practice adaptive behaviors and evaluates the effectiveness of these efforts There is clarification of perceptions and expectations about the relationship
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C. Termination stage
Or resolution stage The nurse evaluates outcomes, reassess the problems,
goals, and interventions Needs close attention to avoid destroying the benefits gained from the relationship The nurse and client express feeling regarding the termination of the interactions The nurse observes the client for regressive behaviors The nurse evaluates the entire nurse-client relationship
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