Core Concepts On Therapeutic Communicatio1
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CORE CONCEPTS ON THERAPEUTIC COMMUNICATION. Communication – refers to the reciprocal exchange of ideas between or among persons. Elements of Communication: •
Sender – originator of information.
•
•
Differences between the denotative and connotative meaning. Incongruent communication.
Common techniques in communication To initiate conversation:
•
Message – information being transmitted.
- Giving broad openiong: giving the patient an opportunity to set the direction of the conversation.
•
Receiver – recipient of information.
Example: “Is there anything that you want to talk about?”
Channel – mode of communication.
- Giving recognition: focusing on the positive aspects of the patients personality.
• • •
Feedback – return response. Context – the setting of communication.
Criteria of successful communication:
Example: “I noticed that you combed your hair today.” To establish rapport and build trust
Feedback
•
Appropriateness
•
Flexibility
- Use of silence: refraining from sppech to give the patient a time to sort out thoughts and feelings.
•
Efficiency
To gather information
•
Dysfunctional communication
•
Double blind communication
Example: “Are you saying that…” - Relflecting: directing back ideas, feelings and content. Example: “You feel tense when you fight.” - Restating: repeating what the patient had said. - Summarizing: developing a concise resume of what has transpired NURSE PATIENT RELATIONSHIP - Series of interaction between the nurse and patient in which the nurse assist the patient to attain positive behavioral change. CHARACTERISTICS •
- Giving information: responding with the needed facts.
•
Common problems in communication
- Validating: confirming one’s observation.
- Focusing: assisting a patient to explore a specific topic. Example: Patient: “I can’t decide about…” Nurse: “Let’s talk about that. Perhaps if we talk about it, it will help you to decide.”
It is goal directed, focused on the needs of the patient, planned, time limited and professional.
BASIC ELEMENTS Trust Rapport Unconditional positive regard Setting limits Therapeutic communication PHASES A. PRE-INTERACTION PHASE
• •
• •
• •
Begins when the nurse is assigned to a patient.
•
Phase of NPR in which the patient is excluded as an active participant
•
The longest and most productive phase of the NPR
•
Limit setting is employed
•
Major task: Identification and resolution of the patient’s problems
Nurse feels certain degree of anxiety Includes all of what the nurse thinks and does before interacting with the patient Major task of the nurse: develop self awareness Data gathering, planning for first interaction
B. ORIENTATION PHASE •
Begins when the nurse and the patients interacts for the first time
•
Parameters of the relationship are laid
•
Nurse begins to know about the patient
•
More structured than the orientation phase
Planning and implementation
D. TERMINATION PHASE •
It is a gradual weaning process
•
It is a mutual agreement
•
It involves feelings of anxiety
•
It should be recognized in the orientation phase
•
•
Major task: to assist the patient to review what he has learned and transfer his learning to his relationship with others Evaluation
Major task of the nurse: develop a mutually acceptable contract
•
When goals have been accomplished
•
Determine why the patient sought help
•
When the patient is emotionally stable
•
Establish rapport, develop trust, assessment
•
When the patient exhibits greater independence
•
It is highly individualized
•
Gradually decreased interaction time
•
Focus on future oriented topics
•
Encourage expression of feelings
•
Make the necessary referral
COMMON PROBLEMS AFFECTING COMMUNICATION •
Transference – the development of an emotional attitude of the patient either positive or negative towards the nurse
•
Resistance – development of ambivalent feeling towards selfexploration
•
Counter transference – transference as experienced by the nurse
PRINCIPLES OF CARE IN PSYCHIATRIC SETTINGS •
The nurse views the patient as a Holistic human being with interdependent and interrelated needs
•
The nurse accepts the patient as a unique human being with inherent value and worth exactly as he is.
•
The nurse should focus on the patient’s behavior nonjudgmentally, while assisting the
When to Terminate?
•
C. WORKING PHASE
How to Terminate?
•
When the patient able to cope with anxiety separation, fear and loss
patient to learn more adaptive ways of coping
Sender – originator of information.
•
•
Differences between the denotative and connotative meaning. Incongruent communication.
Common techniques in communication To initiate conversation:
•
Message – information being transmitted.
- Giving broad openiong: giving the patient an opportunity to set the direction of the conversation.
•
Receiver – recipient of information.
Example: “Is there anything that you want to talk about?”
Channel – mode of communication.
- Giving recognition: focusing on the positive aspects of the patients personality.
• • •
Feedback – return response. Context – the setting of communication.
Criteria of successful communication:
Example: “I noticed that you combed your hair today.” To establish rapport and build trust
Feedback
•
Appropriateness
•
Flexibility
- Use of silence: refraining from sppech to give the patient a time to sort out thoughts and feelings.
•
Efficiency
To gather information
•
Dysfunctional communication
•
Double blind communication
Example: “Are you saying that…” - Relflecting: directing back ideas, feelings and content. Example: “You feel tense when you fight.” - Restating: repeating what the patient had said. - Summarizing: developing a concise resume of what has transpired NURSE PATIENT RELATIONSHIP - Series of interaction between the nurse and patient in which the nurse assist the patient to attain positive behavioral change. CHARACTERISTICS •
- Giving information: responding with the needed facts.
•
Common problems in communication
- Validating: confirming one’s observation.
- Focusing: assisting a patient to explore a specific topic. Example: Patient: “I can’t decide about…” Nurse: “Let’s talk about that. Perhaps if we talk about it, it will help you to decide.”
It is goal directed, focused on the needs of the patient, planned, time limited and professional.
BASIC ELEMENTS Trust Rapport Unconditional positive regard Setting limits Therapeutic communication PHASES A. PRE-INTERACTION PHASE
• •
• •
• •
Begins when the nurse is assigned to a patient.
•
Phase of NPR in which the patient is excluded as an active participant
•
The longest and most productive phase of the NPR
•
Limit setting is employed
•
Major task: Identification and resolution of the patient’s problems
Nurse feels certain degree of anxiety Includes all of what the nurse thinks and does before interacting with the patient Major task of the nurse: develop self awareness Data gathering, planning for first interaction
B. ORIENTATION PHASE •
Begins when the nurse and the patients interacts for the first time
•
Parameters of the relationship are laid
•
Nurse begins to know about the patient
•
More structured than the orientation phase
Planning and implementation
D. TERMINATION PHASE •
It is a gradual weaning process
•
It is a mutual agreement
•
It involves feelings of anxiety
•
It should be recognized in the orientation phase
•
•
Major task: to assist the patient to review what he has learned and transfer his learning to his relationship with others Evaluation
Major task of the nurse: develop a mutually acceptable contract
•
When goals have been accomplished
•
Determine why the patient sought help
•
When the patient is emotionally stable
•
Establish rapport, develop trust, assessment
•
When the patient exhibits greater independence
•
It is highly individualized
•
Gradually decreased interaction time
•
Focus on future oriented topics
•
Encourage expression of feelings
•
Make the necessary referral
COMMON PROBLEMS AFFECTING COMMUNICATION •
Transference – the development of an emotional attitude of the patient either positive or negative towards the nurse
•
Resistance – development of ambivalent feeling towards selfexploration
•
Counter transference – transference as experienced by the nurse
PRINCIPLES OF CARE IN PSYCHIATRIC SETTINGS •
The nurse views the patient as a Holistic human being with interdependent and interrelated needs
•
The nurse accepts the patient as a unique human being with inherent value and worth exactly as he is.
•
The nurse should focus on the patient’s behavior nonjudgmentally, while assisting the
When to Terminate?
•
C. WORKING PHASE
How to Terminate?
•
When the patient able to cope with anxiety separation, fear and loss
patient to learn more adaptive ways of coping
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