Therapeutic Communication 423a5t

Communication is the process of conveying

information through a complex variety of verbal and nonverbal behavior and consists of various components like the sender, message to be send, receiver and . The therapeutic interaction between the nurse and the patient helps to develop mutual growth of two individuals and the

world of each is enlarged and enriched by the other. The general goal of nurse-patient interaction is to help the patient to grow.

Therapeutic Communication is a planned process in which the nurse and client develops a trusting relationship within each other and

here the client is free to express thoughts, feelings and options without fear of judgment. It is based on specific and effective communication skills that the nurse learns to implement through careful practice and experience.

Communication is an ongoing, dynamic and multidimensional process. Its basic elements are; sender

message

channel

Feed back

receiver

 Verbal

Communication  Non-Verbal Communication  Symbolic Communication  Meta Communication

 Sender’s

communication skill (Nurse)  Receiver’s understanding level (Clients)  Communication process  Silence



Listening



Giving Broad Openings



Paraphrasing



Offering general leads



Reflecting Feelings



Focusing



Voicing doubt



Clarifying



Reflection



Giving Information



Encouraging formulation of a plan (suggesting)



Testing discrepancies



Using silence

TOUCH IS ONE MECHANISM OF COMMUNICATING,CARING,ING AND NURTURING TO CLIENTS WHO MAY FEEL COMFORT FROM ISOLATION AND FEAR.  THERAPEUTIC TOUCH WAS DEVELOPED IN 1970’S BY DOLORES KRIEGER AND DORA VAN GELDER KUNZ . 



Giving Advices



Challenging



Defending



Making Stereotyped Comments



Offering false reassurance



Social Responding



Asking close-ended questions



Changing the subject



Belittling



Probing



Giving reassurance



Rejecting



Interpreting

It is a close, helping relationship based on trust, which allows the nurse and client to work collaboratively and effectively and to achieve the developmental goals. It is a nurse – patient therapeutic relationship.

Rapport  Trust  Respect  Genuineness  Empathy 



Goal Oriented

Interventions 

Identify what is troubling the client at the present time.



Encourage the client to discuss changes he or

she would like to make. 

Discuss with the client which changes are possible and which are not possible.

 Have

the client explore feelings about aspects

that cannot be changed and alternative ways of coping more adaptively.  Discuss

alternative strategies for creating

changes the client desires to make.  Weigh

the benefits and consequences of each

alternative.  Assist

the client to select an alternative.



Encourage the client to implement the change



Provide positive for the client’s attempts to create change.



Assist the client to evaluate outcomes of the change and make modifications as required.

 Therapeutic

Use of Self  Gaining Self-Awareness  Values Clarification  Beliefs Rational beliefs  Irrational beliefs  Faith (sometimes called “blind beliefs”)  Stereotype  Attitudes  Values 

 The

Johari Window It is representation of the self and a tool that can be used to increase selfawareness. It is divided into 4 quadrants;  The Open or Public Self  The Unknowing Self  The Private Self  The Unknown Self

 The

pre-interaction phase  The orientation phase (introductory)  The working phase  The termination phase



Phases:



(i) Pre-interaction phase perception

-

Explore self



(ii) Orientation (introductory) formulate

-

Establish trust



(iii) Working change



(iv) Termination

Goals:

Contract for intervention Promote client - Evaluate goal attainment ensure therapeutic closure

 Resistance  Transference  Counter

Transference  Gift giving  Boundary violations

Peplau (1991) identified several sub roles within the role of the nurse. They are  The Stranger  The Resource person  The Teacher  The Leader  The Surrogate  The Counselor



K. Lalitha , “Mental Health & Psychiatric Nursing” 1st edition, W.M.G. Book House Publications, 2007, Page No:160-165



Townsent M.C., “Psychiatric Mental Health Nursing”, 5th edition, Jaypee Publications, New Delhi, 2007, Page No:111-113



Kalpan and Saddocks, “Comprehensive Textbook of Psychiatry”, 7th edition, volume I, Lippincott William, Philadelphia, 2000,Page No:214-215



Stuart.W., “Principles and Practice of Psychiatry Nursing”, 8th edition, Mosley Publications, 2005

 Kalpan

and Saddocks, “Synopsis of Psychiatry”, 8th edition, B.I. Waverly Pvt. Ltd. Publications, New Delhi, 1998, Page No.249 – 259

 Taylor

E, “ Health Psychology, 6th edition, Tata McCraw Hill Publishers, 2006, Page No:252-266

 Erb’s

& Kozier, “Fundamentals of Nursing”, 8th edition, Pearson Publications, 2008, Page No: 1060-1066