Therapeutic Comm

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Author:
Marie
ID:
185495
Filename:
Therapeutic Comm
Updated:
2012-11-26 20:37:21
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Therapeutic Comm
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Therapeutic Comm
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  1. •“Is there something you’d like to talk about?”
    •“Where would you like to begin?”
    •So tell me, how are you doing today?”
    •“I see you frowning. What is going on?”
    BROAD OPENINGS
  2. •“Go on.”
    •“And then?”
    •“Tell me about it.”
    GENERAL LEADS
  3. •“You appear tense.”
    •“Are you uncomfortable when…”
    •“I notice that you’re biting your lip.”
    •“I see you sitting here in the corner of the room away from everyone else.”
    •“I noticed that your breakfast tray still had a lot of food on it.”
    SHARING OBSERVATIONS
  4. •Neutral and non-judgmental
    •The ability to understand and accept another person’s reality, to accurately perceive feelings and to communicate this understanding to others.
    •These statements show the nurse heard the facts and the feelings content, they are neutral, non-judging. 
    •It must be very frustrating to know what you want and not be to get it or tell us what to get
    •“It must be very frustrating to know what you want to say and not be able to say it.”
    SHARING EMPATHY
  5. •“I believe you will find a way to face your situation, because I have seen your courage and creativity in the past.”
    SHARING HOPE
  6. •Improves client self-esteem and made nurses seem more approachable, reduces stress and tension, provides social control, permits cognitive reframing, expresses emotion
    •Goal to bring hope and joy to enhance client well-being and therapeutic communications
    SHARING HUMOR
  7. •Feelings are not right or wrong, not good or bad
    •It is ok to share feelings of caring, even cry with someone
    •“I am worried about you, who will get you back and forth from chemotherapy?”
    •“I am sad that you are having such a difficulty time right now.”
    SHARING FEELINGS
  8. •Powerful form of communication
    •Can convey affection, emotional support, encouragement, tenderness, personal attention
    •It increases sense of safety, self-confidence, decreases anxiety
    •Should be gentle or as firm as needed and delivered in comforting, non-threatening manner
    USING TOUCH
  9. USING SILENCE
    • •Takes time to get comfortable with silence
    • •It can allow opportunity to observation especially of non-verbal cues, sort thoughts and feelings, consider decisions, think of how to word response
    • •Demonstrates patience and willingness to wait for a response from client
    • •Especially therapeutic during times of profound sadness or grief
  10. PROVIDING INFORMATION
    • •Telling what client needs or wants to know, must always consider pacing, how sensitive the information is and what their level of understanding is:
    • –So they can make decisions
    • –Decrease anxiety
    • –Feel safe and secure
    • •“Mr. Smith, your heart sounds have changed from earlier today, and so has your blood pressure.  I’ll let your doctor know.”
    • •“Hello Mrs. Jones, my name is ….. And I will be working as a student nurse with you today.”
  11. •Check heard or understood message correctly
    •“I’m not sure I understand what you mean by ‘sicker than usual”
    •“I’m not sure that I follow.”
    •“Have I heard you correctly.”
    CLARIFYING or SEEKING INFO
  12. •Not to interrupt but to concentrate on elements or concepts or guide conversation
    •“We’ve talked a lot about your medications, but let’s look more closely at the trouble you’re having in taking them on time.”
    •“This point seems worth looking at more closely.”
    •“Of all the concerns you’ve mentioned, which is most troublesome.”
    FOCUSING
  13. •Restating another’s message without changing the meaning
    •Client states: “I have been overweight all my life and never had any problems.  I can’t understand why I need to be on a diet.”
    –INCORRECT: “You don’t care if you're overweight or not.”
    -CORRECT: “You’re not convinced you need a diet because you’ve stayed healthy.”
    PARAPHRASING
  14. ASKING RELEVENT QUESTIONS
    • •Asking questions – what is your biggest concern right now?
    • •How has your pain affected you home life?
  15. •Precise review of key aspect of an interaction
    •“You’ve told me a lot of things about why you don’t like this job and how unhappy you’ve been.  We’ve also come up with some possible ways to make things better, and you’ve agreed to try some and let me know if any of them help.”
    •“Have I got this straight?”
    •“You’ve said that. . .”
    •“During the past hour, you and I have discussed.”
    SUMMARIZING
  16. •Subjectively true, personal experiences shared with client for purpose of showing client nurse understands their experience
    •Expression of genuineness, honesty and empathy
    •Use infrequently
    •“That happened to me once too, and it was devastating, and I had to face some things about myself that I didn’t like.  I went for counseling, and it really heaped.   What are your thoughts about seeing a counselor.”
    SELF-DISCLOSURE
  17. •Help them become aware of inconsistencies in his or her feelings, attitudes, beliefs and behaviors
    •Improves self-awareness
    •Only after trust is established
    •With great tact and sensitivity
    •“You said you’ve already decided what to do, yet you’re still talking a lot about your options.”
    CONFRONTATION
  18. •Delving further into a subject or idea
    •“Tell me more about that.”
    •“Would you describe it more fully.”
    •“What kind of work?”
    EXPLORING
  19. •Making oneself available
    •“I’ll sit with your awhile, ok.”
    •“I’ll stay here with you.”
    •“You can hold my hand while they are inserting the central line.”
    OFFERING SELF
  20. •Directing client actions, thoughts and feelings back to client
    •Client states: “Do you think I should tell the doctor….”
    •Nurse: “Do you think you should?”
    •Client states: “My brother spends all my money and then has nerve to ask for more.”
    •Nurse: “This causes you to feel angry?”
    REFLECTING
  21. •Repeating the main idea expressed
    •Client: “I can’t sleep, I stay awake all night.”
    •Nurse: “You have difficulty sleeping.”
    •Client: “I am really mad, I am really upset.”
    •Nurse: “You’re really mad and upset.”
    RESTATING
  22. Nontherapeutic Communication Techniques
    • •Asking personal questions
    • •Giving personal opinions or Advising
    • •Changing the subject
    • •Automatic responses
    • •False reassurance or reassuring
    • •Sympathy
    • •Asking for explanations
    • •Approval or disapproval
    • •Defensive responses
    • •Passive or aggressive responses
    • •Arguing
    • •Belittling feelings
    • •Challenging

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