Ch 2A Therapeutic Communication

8/9/2019 Ch 2A Therapeutic Communication

1/20

RelationshipDevelopmentand

TherapeuticCommunication

7/19/2010 1


2/20

Introduction

The nurse-client relationship is the

foundation on which psychiatric

nursing is established. The therapeutic interpersonal

relationship is the process by which

nurses provide care for clients inneed of psychosocial intervention.

7/19/2010 2


3/20

Introduction (cont.)

Therapeutic use of self is the

instrument for delivery of care to

clients in need of psychosocialintervention.

Interpersonal communication

techniques are the tools ofpsychosocial intervention.

7/19/2010 3


4/20

TheTherapeutic Nurse-Client

Relationship

Therapeutic relationships are goal- oriented

and directed at learning and growth

promotion.

How do Social Relationships differ from

Therapeutic Relationships?

7/19/2010


5/20

Therapeutic Use of Self

The ability to use ones personality

consciously and in full awareness in an

attempt to establish relatedness and to

structure nursing interventions

7/19/2010

Nurses must possess self-awareness, self-understanding, and a philosophical belief about

life, death, and the overall human condition


6/20

Conditions Essential to Developmentof a Therapeutic Relationship

Rapport Trust

Respect

Genuineness

Empathy

7/19/2010 6


7/20

Phases of a

Therap

eutic Nurs

e-ClientRelationship

Pre-interaction phase

Orientation/Introductory Period

Working

Termination

7/19/2010 7


8/20

Proxemics: Use of Space

7/19/2010 8

Intimate distance - the closest distance thatindividuals allow between themselves and others

Personal distance - the distance for interactions

that are personal in nature, such as closeconversation with friends

Social distance - the distance for conversation withstrangers or acquaintances

Public distance - the distance for speaking in publicor yelling to someone some distance away


9/20

Nonverbal Communication:

Body Language

Components of nonverbal communication:

Physical appearance and dress

Body movement and posture Touch

Facialexpressions

Eye behavior

Vocal cues or paralanguage

7/19/2010 9


10/20

Therapeutic Communication Techniques

Using silence - allows client to take controlof the discussion, ifhe or she so desires

Accepting - conveys positive regard

Giving recognition - acknowledging,indicating awareness

Offering self - making oneself available

Giving broad openings - allows client toselect the topic

7/19/2010


11/20

Therapeutic Communication Techniques (cont.)

Offering general leads - encourages clientto continue

Placing the event in time or sequence -clarifies the relationship ofevents in time

Making observations - verbalizing what isobserved or perceived

Encouraging description ofperceptions - asking client to verbalizewhat is being perceived

7/19/2010 11


12/20


Encouraging comparison - asking client tocompare similarities and differences in ideas,

experiences, or interpersonal relationships

Restating - lets client know whether anexpressed statement has or has not been

understood

Reflecting - directs questions or feelingsback to client so that they may be recognized

and accepted

7/19/2010 12


13/20


Focusing - taking notice of a single idea oreven a single word

Exploring - delving further into a subject,

idea,experience, or relationship Seeking clarification and validation -

striving to explain what is vague and searching

for mutual understanding Presenting reality - clarifying

misconceptions that client may beexpressing

7/19/2010 13


14/20

How To Set Limits on Inappropriate

Behavior?

Accept the person; Reject the behavior

Best approach: Be firm, but accepting

7/19/2010

Mr D, I really enjoy playing monopolywith you, but I dont like it when youswear. I am wondering if you can

express your angry feeling in anothermanner?


15/20

Active Listening

To listen actively is to be attentive to

what client is saying, both verbally and

nonverbally. Several nonverbal behaviors have been

designed to facilitate attentivelistening.

7/19/2010 15


16/20

Active Listening (cont.)

S Sit squarely facing the client

O Observe an open posture

L Lean forward toward the client

E Establisheye contact

R Rel

ax

7/19/2010 16


17/20

Process Recordings

Written reports of verbal interactions

with clients

A means for the nurse to analyze thecontent and pattern of interaction

A learning tool for professional

development

7/19/2010 17


18/20

Nontherapeutic Communication Techniques

Giving reassurance - may discourage clientfrom further expression of feelings if clientbelieves the feelings will only be downplayedor ridiculed

Rejecting - refusing to consider clients ideasor behavior

Approving or disapproving - implies that

the nursehas the right to pass judgment onthe goodness or badness of clientsbehavior

7/19/2010


19/20

Nontherapeutic Communication Techniques (cont.)

Agreeing or disagreeing - implies that thenursehas the right to pass judgment onwhether clients ideas or opinions are rightor wrong

Giving advice - implies that the nurse knowswhat is best for client and that client isincapable of any self-direction

Probing - pushing for answers to issues theclient does not wish to discuss causes client tofeel used and valued only for what is sharedwith the nurse

7/19/2010


20/20

Nontherapeutic Communication Techniques (cont.)

Defending - to defend what client has criticized

implies that client has no right to express ideas,

opinions, or feelings

Requesting an explanation - asking why impliesthat client must defend his or her behavior or

feelings

Belittling feelings expressed - causes client to

feel insignificant or unimportant Introducing an unrelated topic - causes the

nurse to take over the direction of the discussion

7/19/201020

Ch 2A Therapeutic Communication

Documents

Transcript of Ch 2A Therapeutic Communication