PRESENTED BY:- Balkeej kaur M.Sc (N) Ist yr Roll no- 08

THERAPEUTIC COMMUNICATION

The therapeutic interaction between nurse and the client will be helpful to develop mutual understanding between two individuals.

Interaction is a learning experience for both client and for the nurse , and a corrective emotional experience to the client to modify his behavior.

It establishes trusting relationship, wins the confidentiality whereby the client

It can reveal his thought and feelings openly.

INTRODUCTION

“The nurse directs the communication towards the patient to identify his current problems, plans, implements and evaluates the action taken”.

(Bimla kapoor,2002)

“promotes mutual understanding, establishes a constructive relationship between the nurse and the client”.

(kozier,2004)

DEFINITION:

To achieve self realization, self acceptance, self respect, personal identity.

To formulate good interpersonal therapeutic relationship.

Satisfy needs and to achieve realistic personal goals.

Permits the client to express their thoughts truly, openly.

Aids in clarification of internal conflicts and frustrations of the client

Objectives

Improves client’s ego strengthsEncourage socialization and family interaction

processTreats communication problemsModifies maladaptive behavior into adaptive

behaviorMotivates the client to utilize new coping strategiesHelps the nurse to identify and intervene appropriate

nursing approaches.Assists the client to develop self control and utilizes

problem solving skills in attacking the problems.Implements nursing process effectively.

CONTI……..

COMMUNICATION PROCESS

Intrapersonal communication

Interpersonal communication

Transpersonal communication

Small group communication

Public communication

LEVELS OF COMMUNICATION

It occurs within an individual. This level of communication is also called self talk, inner thought and inner dialogue.

Intrapersonal communication

It is one to one interaction between the nurse and another person that often occurs face to face. Meaningful interpersonal communication results in exchange of ideas, problem solving, expression of feelings, decision making and personal growth.

Interpersonal communication

It occurs within a person’s spiritual domain. Many persons use prayer, meditation religious rituals to communicate with their higher power. Nurses who value the importance of human spirituality often use this form of communication with clients and for themselves.

Transpersonal communication

It occurs when a small number of persons meet together. It is usually goal directed and requires an understanding of group dynamics. Nurses use this level of communication for group therapy.

Small group communication

It is the interaction with the audience. Nurses have opportunities to speak with groups of consumers about health related topics, present scholarly work to colleagues at conferences or lead classroom discussions.

Public communication

Verbal CommunicationNonverbal Communication

FORMS OF COMMUNICATION

Verbal communication refers to the form of communication in which message is transmitted verbally. Objective of every communication is to have people understand

what we are trying to convey. 

Verbal Communication

Oral Communication: In oral communication, Spoken words are

used. It includes face-to-face conversations, speech, telephonic conversation, video, radio, television, voice over internet. In oral communication, communication is influence by pitch, volume, speed and clarity of speaking.

Advantages of Oral communication:It brings quick feedback.In a face-to-face conversation, by reading

facial expression and body language one can guess whether he/she should trust what’s being said or not.

Nonverbal communication is the sending or receiving of wordless messages. We can say that communication other than oral and written, such as gesture, body language, posture, tone of voice or facial expressions, is called nonverbal communication.Nonverbal communication is all about the body language of speaker.

Nonverbal Communication

Nonverbal communication have the following three elements:

AppearanceSpeaker: clothing, hairstyle, neatness, use of cosmeticsSurrounding: room size, lighting, decorations, furnishings

Body Languagefacial expressions, gestures, postures

SoundsVoice Tone, Volume, Speech rate

Written CommunicationIn written communication, written signs or

symbols are used to communicate. A written message may be printed or hand written. In written communication message can be transmitted via email, letter, report, memo etc.

Advantages of written communication includes:Messages can be edited and revised many time before it is actually sent.Written communication provide record enables receiver to fully understand it and send appropriate feedback.

Disadvantages of written communication includes:Unlike oral communication, Written communication doesn’t bring instant feedback.It take more time in composing a written message

Changing topic without listening

Offering challenges

Too much advising

Belittling the patient will reinforce with drawl features of client

CONTI……

Intimate zone( 0 to 18 inches):1. Holding a crying infant2. Performing physical assessment3. Bathing, grooming, dressing, feeding a

client

Personal zone(18 inches to 4 feet):1. Sitting at client’s bedside2. Taking the client’s nursing history3. Exchanging information at change of shift

ZONES OF PERSONAL SPACE

Social zone( 4 to 12 feet):1. Making rounds with physician2. Sitting at the head of the conference table3. Teaching a class4. Conducting family therapy

Public zone(12 feet and greater):1. Speaking at a community forum

Pre-interaction phaseOrientation phaseWorking phaseTermination phase

PHASES OF THERAPEUTIC RELATIONSHIP

PRE- INTERACTION PHASE:

It begins before the nurse’s first contact with the patient. The nurse’s initial task is one of self exploration.

TASKS DURING PRE-INTERACTIVE PHASE:

Explore own feeling, fantasies and fears.

Analyze own professional strengths and limitations.

Gather data about patient whenever possible.

Plan for first meeting with the client.

INTRODUCTORY OR ORIENTATION PHASE:

During this phase, the nurse sets the stage for one to one relationship by becoming acquainted with the patient. Both the nurse and the patient may experience anxiety when they first meet. The reason for seeking help forms the basis for nursing assessment and helps the nurse to focus on the patient’s problem and to determine patient motivation.

TASKS DURING INTRODUCTORY PHASE:Building trust and rapport.therapeutic environment.Establishing a mode of communication

acceptable to both the patient and nurse.Initiating a therapeutic contract by establishing

a time, place and duration for each meetingAssessing the patient’s strengths and

weaknesses.To explore patient’s perceptions, thoughts,

feelings and actions.To identify patients pertinent problems.To define mutual, specific goals with the client.

WORKING PHASE:The nurse and the patient explore relevant

stressors and promote the development of insight in the patient by linking perception, feelings, thoughts and actions.

The nurse helps the patient to master anxieties, increase independence and self responsibility, and develop constructive coping mechanisms.

Actual behavior change is the focus of this phase. Patient usually displays resistance during this phase. The patient begins to relax, trust the nurse.

TASKS IN WORKING PHASE:Exploring perception of reality.Developing positive coping behavior.Identifying available support systems.Promoting a positive self concept.Encouraging verbalization of feelings.Developing a realistic plan of action.Implementing the plan of action.Evaluating the results of plan of action.Promoting independence.

TERMINATION PHASE:It is the most difficult but most important phase

of therapeutic relationship. During the termination phase, learning is maximized for both the patient and the nurse. It is a time to exchange feelings and memories and to evaluate mutually the patient’s progress and goal attainment. sense of loss experienced by both the nurse and the patient.

General ability e.g. ability to listen, interpret, speak and express through writing

Special abilities

-Process the therapeutic interaction to attain the goals -Ability to differentiate and follow when to be silent,

speak, smile, interact-Ability to wait, proceed, speed-Participates actively and maintains therapeutic nurse-

patient relationship

THERAPEUTIC COMMUNICATION SKILLS REQUIRED FOR NURSE

Not listening properly

Maintaining dominance

False hopes

Too much probing in to personal matters

Making stereotyped comments

BARRIERS TO THERAPEUTIC COMMUNICATION

Courtesy:The nurses say hello and goodbye as a common

courtesy. Knocks the door before entering the room, uses self introduction, addresses people by name, says thank you and please.

Use of names:Nurse’s failure to give a name indicate status or

acknowledge the client can create uncertainity about interaction and convey an impersonl lack of commitment or caring.

ELEMENTS OF PROFESSIONAL COMMUNICATION

Privacy and confidentiality:It is safe guard the client’s right to privacy by

carefully protecting information of the client. Gossiping violates nursing ethical codes and standards.

Trustworthiness:Being trustworthy means helping others

without hesitating. To foster trust the nurse communicates warmth, demonstrates consistency, reliability and honesty.

Autonomy and responsibility:It is the ability to be self directed in

accomplishing the goals. Nurses can take initiative for problem solving. Nurses support client autonomy by respecting the person’s rights, values and decisions.

Follow certain limitations .

Avoid too personal involvement .

Ambiguity and misunderstanding with other staff has to be avoided.

Avoid adverse feelings.

Ethics and moral principles have to be followed

RESPONSIBILITIES OF A NURSE IN THERAPEUTIC COMMUNICATION

Summarization

Recapitulization

ANY QUERY

THANK YOU