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Therapeutic Communication Prepared by Sally McDonald Revised by Tim Corbett.

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Presentation on theme: "Therapeutic Communication Prepared by Sally McDonald Revised by Tim Corbett."— Presentation transcript:

1 Therapeutic Communication Prepared by Sally McDonald Revised by Tim Corbett

2 Helping vs Social Relationships HELPING HELPING Care Care Trust Trust Growth Growth Purposeful/intention al Purposeful/intention al Unequal sharing Unequal sharing Focus on Clients needs Focus on Clients needs Time limited Time limited SOCIAL SOCIAL Care Care Trust Trust Growth Growth Spontaneous Spontaneous Usually equal or near equal sharing Usually equal or near equal sharing Focus on needs of Focus on needs of both individuals both individuals Ongoing Ongoing

3 Locus of Control GIVING HELP GIVING HELP Feeling important Feeling important Feeling useful Feeling useful Feeling powerful Feeling powerful Feeling gratified Feeling gratified Feeling happy Feeling happy NEEDING HELP NEEDING HELP Feeling unimportant or inadequate Feeling unimportant or inadequate Feeling useless or depressed Feeling useless or depressed Feeling powerless Feeling powerless Feeling frightened or embarrassed Feeling frightened or embarrassed Feeling sad Feeling sad or angry or angry

4 Phases of Helping Relationships Orientation Phase Orientation Phase Working Phase Working Phase Termination Phase Termination Phase

5 Orientation Phase getting to know you phase getting to know you phase setting the tone setting the tone making introductions making introductions establishing roles establishing roles reaching agreement on goals reaching agreement on goals developing trust developing trust

6 Working Phase problem solving phase problem solving phase attending to clients needs attending to clients needs Nurse in role of teacher/counselor Nurse in role of teacher/counselor encouraging active participation by client encouraging active participation by client gathering further data gathering further data assisting client in decision making assisting client in decision making facilitating change facilitating change Evaluate problems & goals Evaluate problems & goals

7 Termination Phase reviewing & summarizing goals met and progress made reviewing & summarizing goals met and progress made acknowledge feelings of loss acknowledge feelings of loss reassuring clients with issues such as, reassuring clients with issues such as, How will this problem/disease affect How will this problem/disease affect my life ? or my life ? or What do I need to change ? What do I need to change ?

8 Communication Techniques Validating/Clarifying Validating/Clarifying Reflecting Reflecting Sequencing Sequencing Sharing observations Sharing observations Acknowledging feelings Acknowledging feelings

9 Avoid Arguing Arguing Minimizing Minimizing Challenging Challenging Giving false reassurance Giving false reassurance Interpreting or speculating on the dynamics of the clients problems Interpreting or speculating on the dynamics of the clients problems Selling client on accepting treatment Selling client on accepting treatment Probing sensitive areas Probing sensitive areas Participating in criticism of any staff member Participating in criticism of any staff member Joining any attacks led by the client Joining any attacks led by the client

10 Attentive Listening Scale -THINGS TO AVOID Lack of eye contact Lack of eye contact Responding before the other finishes speaking Responding before the other finishes speaking Finishing other peoples sentences Finishing other peoples sentences Talking so much that others cannot respond Talking so much that others cannot respond Continuing to work while someone is talking to you Continuing to work while someone is talking to you Repeat a point just made Repeat a point just made Allow your mind to wander during a conversation Allow your mind to wander during a conversation

11 Active Listening 3 Phases 3 Phases restatement involves repeating or paraphrasing the words of the client restatement involves repeating or paraphrasing the words of the client reflection is verbalizing both the content and the implied feelings of the clients message reflection is verbalizing both the content and the implied feelings of the clients message clarification is summarizing the clients thoughts & feelings & resolving confusion clarification is summarizing the clients thoughts & feelings & resolving confusion

12 Active Listening STOP TALKING STOP TALKING demonstrate that you want to listen demonstrate that you want to listen remove distractions remove distractions be patient be patient STOP TALKING STOP TALKING

13 Assertive Communication I Statements allow people to own (take responsibility for) their own thoughts & feelings I Statements allow people to own (take responsibility for) their own thoughts & feelings assertiveness involves taking a risk assertiveness involves taking a risk

14 NONVERBAL CUES professional attire professional attire sit arms length away sit arms length away relaxed but attentive posture relaxed but attentive posture

15 NONVERBAL CUES facial expressions and tone facial expressions and tone should be friendly & interested should be friendly & interested use direct eye contact & match your eye contact with the patients eye contact use direct eye contact & match your eye contact with the patients eye contact pay attention to body language of patient as well as your own body language pay attention to body language of patient as well as your own body language

16 Interviewing Techniques

17 INTERVIEWING TECHNIQUES the purpose of the interview is to obtain accurate & thorough information the purpose of the interview is to obtain accurate & thorough information put your client at ease as they may feel uncomfortable about revealing sensitive information to you put your client at ease as they may feel uncomfortable about revealing sensitive information to you explaining your format helps clients accept & understand the purpose of the interview explaining your format helps clients accept & understand the purpose of the interview

18 INTERVIEWING TECHNIQUES in general, use open-ended questions in general, use open-ended questions however, to obtain specific information, closed-ended questions are preferable however, to obtain specific information, closed-ended questions are preferable validate information validate information clarify responses clarify responses use reflective questions/comments use reflective questions/comments & paraphrasing & paraphrasing

19 Progression of the Interview Broad Openings- such as Broad Openings- such as Tell me about yourself are designed to allow the client to relate his or her story in a way that is comfortable Tell me about yourself are designed to allow the client to relate his or her story in a way that is comfortable

20 Progression of the Interview Open-Ended Questions Open-Ended Questions encourage the client to elaborate or give explanations (for example, encourage the client to elaborate or give explanations (for example, What happened yesterday?) What happened yesterday?) they provide direction & keep the conversation focused they provide direction & keep the conversation focused

21 Progression of the Interview Closed-Ended Questions Closed-Ended Questions can be answered with 1-2 words and can be useful in obtaining specific types of information, such as can be answered with 1-2 words and can be useful in obtaining specific types of information, such as What is todays date? What is todays date?

22 EFFECTIVE INTERVIEWING as a professional nurse, you will spend about half of your time obtaining information from clients & colleagues as a professional nurse, you will spend about half of your time obtaining information from clients & colleagues excellent communication as well as interviewing skills are fundamental, yet require years of practice excellent communication as well as interviewing skills are fundamental, yet require years of practice

23 WHY, WHAT, HOW why do you need the information? why do you need the information? how will the information I am seeking direct me in helping my client? how will the information I am seeking direct me in helping my client? how will you phrase your questions? how will you phrase your questions?

24 Who to Ask? if the client is able to speak, ask him/her if the client is able to speak, ask him/her family perspectives may also be important family perspectives may also be important written consent may be required to question concurrent/previous healthcare providers written consent may be required to question concurrent/previous healthcare providers be courteous and respectful be courteous and respectful never forget client confidentiality never forget client confidentiality

25 Why Questions offensive misuse of why appears threatening and confrontational and puts clients on the defensive offensive misuse of why appears threatening and confrontational and puts clients on the defensive they can interfere with developing a therapeutic relationship & are seldom considered therapeutic they can interfere with developing a therapeutic relationship & are seldom considered therapeutic

26 Conveying Upsetting Information The SPIKES Model developed by Radziewicz & Baile (2001) The SPIKES Model developed by Radziewicz & Baile (2001) Setting Setting Perception Perception Invitation Invitation Knowledge emotions Knowledge emotions Summary Summary

27 Setting private & comfortable private & comfortable invite others, such as family members invite others, such as family members

28 Perception refers to what client and others already know useful in uncovering misinformation refers to what client and others already know useful in uncovering misinformation

29 Invitation For example, the statement, For example, the statement, Would you like me to explain more Would you like me to explain more about what happened? about what happened?

30 Knowledge gradually dispense information assessing clients ability to cope with it gradually dispense information assessing clients ability to cope with it The family may insist that the client not be told difficult news The family may insist that the client not be told difficult news

31 Emotions let client vent while you remain calm let client vent while you remain calm keep in mind Stages of Grief & Loss keep in mind Stages of Grief & Loss may need to set limits on inappropriate /harmful behavior may need to set limits on inappropriate /harmful behavior

32 Summary review all important information with the client and family review all important information with the client and family may need to repeat information more than once may need to repeat information more than once

33 AVOID clichés clichés poor listening poor listening closed questions closed questions intimidating how/why questions intimidating how/why questions obvious probing questions obvious probing questions advice advice leading questions (that suggest the response leading questions (that suggest the response that you want) that you want) judgmental comments judgmental comments diverting diverting false assurance false assurance

34 COMMON ERRORS

35 Blocks to Communication Failure to respect client Failure to respect client Failure to listen Failure to listen Minimizing feelings Minimizing feelings Inappropriate comments & questions Inappropriate comments & questions Excessive questions Excessive questions Clichés Clichés Yes/no questions Yes/no questions Probing Probing Changing the subject Changing the subject Leading questions Leading questions Advice Advice Judgments Judgments False reassurance False reassurance Giving approval/disapproval Giving approval/disapproval

36 Self-Disclosure Use self disclosure to help clients open up Use self disclosure to help clients open up to you – not to meet your own needs to you – not to meet your own needs Keep disclosures brief Keep disclosures brief Dont imply that your experience is exactly the same as the clients Dont imply that your experience is exactly the same as the clients Only self-disclose about situations that you have mastered Only self-disclose about situations that you have mastered

37 Self-Disclosure Monitor your own comfort with Monitor your own comfort with self-disclosure self-disclosure Respect your clients needs for privacy Respect your clients needs for privacy Remember that there are cultural variations in the amount of self- disclosure considered appropriate Remember that there are cultural variations in the amount of self- disclosure considered appropriate Identify risks and benefits of self disclosure Identify risks and benefits of self disclosure

38 Therapeutic Versus Nontherapeutic Communication THERAPEUTIC THERAPEUTIC - Facilitates transformation of working nurse-patient relationship - Relationship allows for adequate & accurate data collection & assessment - Performed with & not for patient

39 Therapeutic Versus Nontherapeutic Communication NONTHERAPEUTIC NONTHERAPEUTIC - Hinders relationship formation - Prevents patient from becoming mutual partner & relegates him/her to passive recipient of care


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