Psychiatric-Mental Health Nursing - Communication

Therapeutic Communication:

BASIC CONCEPT

Communication is the process that people use to exchange information. Messages are simultaneously sent and received on two levels the use of words and nonverbally by behaviors that accompanied the words (Blazer Riley, 2000).Rothman and Sward (1958) describe three interrelated component systems of communication: spoken language, vocalization, and nonverbal/body language.

Therapeutic communication is a goal-directed, interpersonal interaction between the nurse and the patient, specifically fitted to the needs of the patient to promote an effective exchange of information. The process involves the exchange of ideas, feelings and attitudes related to the desired care outcomes. Here “patient” refers to the individuals, family and groups who seek nursing care.

Establishing a therapeutic relationship is one of the most important responsibilities of the nurse when working with patients. Communication is the means by which a therapeutic relationship is initiated, maintained and terminated.

It should be patient-centered approach.Within the nurse-client relationship, any exchange of information between the two individuals also carries message about how to interpret the communication.
 
Characteristics:

 Goal Directed – Emphasis is placed on reaching realistic solutions to health care problems and to client’s concern. These discussions occur within the context of clear definition of values, purposes and goal related to the specific nursing diagnosis and the relationship leads of the patient. Always the nurse considers “What is the purpose or objective of the interaction of asking questions?” “What are the main points to be shared’ and in what order? Adhering to relationship goals is an art requiring conscious effort and considerable practice.

 Descriptive and Nonjudgmental – Therapeutic communication is a specific form of dialogue that is descriptive, problem focused and supportive of the patient’s strengths. Such communication considered the patient’s perspective, readiness, ways of relating to others, physical emotional conditions, and sociocultural norms as relevant factors in planning and implementation of nursing interventions. Principles of therapeutic communication in the nurse-patient relationship involve the whole person (Barnlund, 1986).

 Defined Rules and Boundaries – therapeutic communication has defined rules and guiding implementation and prescribes interpersonal boundaries. Comments are descriptive rather than judgmental. The communication takes place within health care settings and interactions usually are time limited. Each person’s role, abilities and boundaries are clearly recognizable by all participants. This is important to remember because some patient and nurses would like to allow a satisfying relationship to extent beyond goal achievement.

 Client-Focused - requires that the focus be on the patient’s needs. It is important for the nurse to see potential or actual health problems and needs of the patient’s perspective.

 Individualized strategies – with practice the nurse learns to adapt broad communication principles, keeping the individualized communication needs of each patient. Since people are unique and different from each other, approach must be individualized. Choosing the right communication strategy to meet the unique needs of each situation is the art of nursing.

Weingarten (1992) notes, “Every conversation creates an opportunity for connection and disconnection; reflection and haste; dialogue and monologue; understanding and misunderstanding; collaboration and instruction; no change and change.” Verbal messages are decisive factors in the nurse-patient relationship. The nurse can make or break interpersonal bonds with the words used with clients. Verbal messages are central to all forms of nursing care. The nurse uses language to help clients connect different parts of their stories. Verbal messages are used as a means of problem solving; they also comfort, challenge and provide information to client in distress.
 
Therapeutic Communication Techniques:
 

•  Accepting – indicating reception
• Broad openings – allowing the client to take the initiative in introducing the topic.
• Consensual validation – searching for mutual understanding, for accord in the meaning of the words.
• Encouraging comparison – asking that similarities and differences be noted.
• Encouraging description of perception – asking the client to verbalize what the client verbalize what he or she perceives.
• Encouraging expression – asking client to appraise the quality of his or her experiences.
• Exploring – delving further into a subject or idea.
• Focusing – concentrating on a single point.
• Formulating a plan of action – asking the client to consider kinds of behavior likely to be appropriate in future situations.
• General leads - giving encouragement to continue.
• Giving information - making available the facts that the client needs.
• Giving recognition - acknowledging, indicating awareness.
• Making observations - verbalizing what the nurse perceives.
• Offering self - making oneself available.
• Placing event in time or sequence - clarifying the relationship of events in time
• Presenting reality - offering for consideration that which is real.
• Reflecting - directing client actions, thoughts, and feeling back to client.
• Restating – repeating the main idea expressed.
• Seeking information – seeking to make clear that which is not meaningful or that which is vague.
• Silence – absence of verbal communication, which provides time for the client to put thoughts or feelings into words, regains composure or continues talking.
• Suggesting collaboration – offering to share, to strive, to work with the client for his or her benefit.
• Summarizing – organizing and summing up that which has gone before.
• Translating into feelings – seeking to verbalize the client’s feeling that he or she expresses only indirectly.
• Verbalizing the implied – voicing what the client has hinted at or suggested.
• Voicing doubt – expressing uncertainty about the reality of the client’s perceptions.

Non therapeutic Communication Techniques:

• Advising – telling the client what to do.
• Agreeing – indicating accord with the client.
• Belittling feelings expressed – misjudging the degree of the client’s discomfort.
• Challenging – demanding proof from the client.
• Defending – attempting to protect someone or something from verbal attack.
• Disagreeing – opposing the client’s ideas.
• Disapproving – denouncing the client’s behavior or ideas.
• Giving approval – sanctioning the client’s behavior or ideas.
• Giving literal responses – responding to a figurate comment as though it were a statement of fact.
• Indicating the existence of an external source-attributing the source of thoughts, feelings and behavior to others or to outside influence.
• Interpreting – asking to make conscious that which is unconscious; telling the client the meaning of his or her experience.
• Introducing an unrelated topic – changing the subject.
• Making stereotyped comments – offering meaningless clichés or trite comments.
• Probing – persistent questioning of the client.
• Reassuring – indicating that there is no reason for anxiety or other feelings of discomfort.
• Rejecting – refusing to consider or showing contempt for the client’s ideas or behaviors.
• Requesting an explanation – asking the client to provide reasons for thoughts, feelings, behaviors or events.
• Testing – appraising the client’s degree of insight.
• Using denial – refusing to admit that a problem exists.