1. Principles of therapeutic communication Dr. Abdul-Monim Batiha

2. Plan to interview at an appropriate time.
The time frame within which an interaction occurs influences the outcome.
For example, it is unwise to plan to talk with a client during visiting hours, during change of shift, or when the client is distracted by environmental stimuli (e.g., the homebound client is watching a favorite television show).
In such situations, the nurse may be rushed or the client may be preoccupied.

3. 2. Assure privacy.
Clients are entitled to confidentiality.
Privacy can be arranged by screening the client’s bed, closing the door to the room, or finding a quiet secluded place in which to talk.
In the home setting, it may be necessary to ask family members or visitors for time and space to promote confidentiality.

4. 3. Establish guidelines for the therapeutic interaction.
During the initial contact with the client, the nurse should share certain information. This includes the nurse’s name and affiliation and the reason for or purpose of the interaction, the expected length of the contact with the client, and the assurance of confidentiality.
The client needs to have this basic information, and it serves as an introduction to the development of the therapeutic nurse client relationship.

5. 4. Provide for comfort during the interaction.
Discomfort can be distracting.
Regulate the temperature of the environment.
Sit in comfortable chairs.
Provide for adequate ventilation.
Implement measures to decrease pain.
5. Accept the client exactly as is.
Being judgmental blocks communication.
Nurses who put aside personal feelings and values are more receptive to the feelings and behaviors of the client, regardless of content stated by the client.

6. 6. Encourage spontaneity.
The nurse gathers more data when the client is talking freely.
Also, the client experiences relief and freedom from worries by talking without inhibition.

7. 7. Focus on the client and on the leads and clues presented.
Asking questions just for the sake of talking or for the satisfaction of one’s own curiosity does not contribute to effective interviewing. Therapeutic interaction involves discussing the client’s problems, needs, or concerns. Therefore, allow the client to initiate the topic to be discussed; then, use techniques to focus on that topic. Pay attention to the verbal, paraverbal, and nonverbal cues and signals of the client, and focus on them when they occur.

8. 8. Encourage the expression of feelings.
Therapeutic interaction occurs when the client is permitted to voice feelings about troublesome events or interpersonal situations.
Doing so requires the nurse to identify those areas that are emotionally charged and to focus on them.

9. 9. Be aware of your own feelings during the interaction.
The nurse’s feelings influence the interaction.
For example, the nurse who becomes anxious may change the subject or make comments that finalize the session.
The nurse must make a conscious effort to prevent personal feelings from getting in the way of the client’s progress.
Identifying one’s own feelings and behavior and recognizing the way they affect the client lead to better communications.

12. Therapeutic Communication Techniques
Techniques that allow the client to set the pace (Offering self, Broad openings, Silence).
Techniques that Encourage Spontaneity (Open-ended comments, Reflection, Restating)
Techniques that focus on the client by responding to verbal, paraverbal, and nonverbal cues (Exploring, Recognition, Focusing, Directing)
Techniques that encourage expression of feelings (Verbalizing the implied, making observations, clarifying)
Techniques that encourage the client to make some changes (Confronting, Limit setting)

13. BARRIERS TO THERAPEUTIC INTERACTION
1. Language Differences
When Arabic is the clients’ second language, they may have problems navigating through the health care system.
An inability to communicate effectively with health care providers adversely affects clients’ responses to interventions.
The impact of this barrier can be lessened by learning the language (or parts of it), or by using interpreters, pictures and symbols, and foreign language dictionaries.

14. 2. Cultural Differences
Various cultures and subcultures use language differently.
A person’s communication patterns reflect their culture. In some cultures, expression of thoughts and feelings is spontaneous and exuberant (excited),
whereas people of other cultural groups may be reserved and stoic in their verbalizations.
Some of the communication variables that are culture specific include eye contact, proximity to others, direct versus indirect questioning, and the role of social small talk.

15. 3. Gender
Sending, receiving, and interpreting messages can vary between men and women.
The effect and use of nonverbal cues are often gender-dependent.
For example,
women tend to be better decoders of nonverbal cues, and men prefer more personal distance between themselves and others than do women (Boggs, 1999).

16. 4. Health Status
One’s health status affects communication.
For example, the client who is oriented will communicate more reliably than a client who is delirious, confused, or disoriented.
Communication is affected by sensory perceptual alterations, such as loss of vision or hearing.

17. 5. Developmental Level
Failure to communicate at the client’s developmental level can be a roadblock.
For example, communication with children requires the use of different words and approaches than are used with adults because a child cannot think in abstract concepts.
Relating at the client’s own developmental level is necessary for understanding.

18. 6. Knowledge Differences
All people need to be understood.
Nurses consistently assess the knowledge levels of clients in order to determine the best way to correct knowledge deficits.
When assessing knowledge level, the nurse should:
1. Take note of the client’s vocabulary
2. Observe the numbers and kinds of facts the client has
3. Determine the client’s educational background.
With this information, the nurse is able to assess the teaching needs of the client, as well as determine the method of instruction to use.

19. 7. Emotional Distance
Emotional distance involves treating the client as a curiosity, a problem, or a disease, thus preventing satisfying interaction and possibly causing hostility.
Consider, for instance, a client who is on strict isolation for an infectious disease, or someone who is confused and disoriented.
By maintaining rapport with clients regardless of their status, nurses are able to decrease emotional distance.

20. 8. Emotions
When the nurse or the client is anxious, communication may change, stop, or take a nonproductive course.
Nurses should be aware of their own feelings and try to control them in order to ensure progress in the interview.
It is important that the nurse present a calm manner in order to ease the client’s apprehension (anxiety) and, thus, improve the quality of communication