Therapeutic Communication Chapter 4: Copyright © 2012, 2007 Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved.

2 Communication  Most powerful tool in psychiatric nursing  The method used to activate the nursing process  Foundation of the nurse-patient relationship  A dynamic process in which two or more people share information

3 Copyright © 2012, 2007 Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Effective Communication  Major factor in determining client:  Satisfaction  Treatment compliance  Recovery  Essential to outcome

4 Copyright © 2012, 2007 Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Figure 4-1 Model of the communication process.

5 Copyright © 2012, 2007 Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Factors that Influence Communication  Environment  Relationship between sender and receiver  Content and context of message  Attitude, values, beliefs  Ethnic background and socioeconomic status  Family dynamics, life experience  Knowledge level  Ability to relate to others

6 Copyright © 2012, 2007 Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Three Purposes of Communication 1. Facilitate self expression for the promotion of healthy growth 2. Understand the significance of the patient’s problems 3. To assist with the identification and resolution of the problems

7 Copyright © 2012, 2007 Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Written Communication  Primarily used to share information  Nurse must be precise and succinct  Organize ideas clearly, write legibly, proper grammar  Document in objective, clear, and concise terms

8 Copyright © 2012, 2007 Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Verbal Communication  Spoken words  May mean different things to different people  Figures of speech, slang, jokes, clichés, colloquialisms

9 Copyright © 2012, 2007 Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Cultural Considerations  Develop sensitivity to cultural aspects of communication  Examine cues from nonverbal responses

10 Copyright © 2012, 2007 Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Nonverbal Communication  Composes 93% of any communication  Body language  Paralinguistics  Space  Touch  Appearance

11 Copyright © 2012, 2007 Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Social Communication  Everyday situations  Family relationships, social activities, school  Superficial, light, and usually does not have a goal

12 Copyright © 2012, 2007 Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Principles of Therapeutic Communication  Know self  Understand what motivates one to help others  Be in control of own life and emotions  Perform periodic self-evaluation of responses to patient

13 Copyright © 2012, 2007 Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Types of Communication  Intrapersonal  Interpersonal  Social  Collegial  Therapeutic

14 Copyright © 2012, 2007 Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Nursing Roles  Role model  Teacher  Socializer  Advocate  Parent  Counselor  Therapist

15 Copyright © 2012, 2007 Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Traits of Therapeutic Communication  Genuineness  Positive regard  Empathy  Trustworthiness  Clarity  Responsibility  Assertiveness

16 Copyright © 2012, 2007 Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Special Communication Techniques  Self-disclosure  Touch  Humor

17 Copyright © 2012, 2007 Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Obstacles to Therapeutic Communication  Resistance  Transference  Countertransference  Boundary violations

18 Copyright © 2012, 2007 Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Responding Techniques That Enhance Therapeutic Communication  Silence  Active listening  Support and reassurance  Sharing observations  Acknowledging feelings  Broad, open-ended statements  Information giving  Interpretation

19 Copyright © 2012, 2007 Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Responding Techniques That Enhance Therapeutic Communication, cont’d  Restating  Reflecting  Clarifying  Confronting  Summarizing  Role-playing

20 Copyright © 2012, 2007 Mosby, Inc., an affiliate of Elsevier Inc. All rights reserved. Challenges in Communication  Legal status/rights  Confidentiality  Informed consent  Brief stays  Physical impairments  Culture, language, and understanding  Difficult patients  Difficult coworkers