Transcript Therapeutic communication

Therapeutic
Communication
the helping interview
Helping Relationship
Characteristics
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Caring
Hopeful
Sensitive
Genuineness
Empathy
Positive regard
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Empowering
Assertive
Helping vs Social
Relationships
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HELPING
Care
Trust
Growth
Purposeful/intentional
Unequal sharing
Focus on Client’s needs
Time limited
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SOCIAL
Care
Trust
Growth
Spontaneous
Usually equal or near
equal sharing
Focus on needs of
both individuals
Ongoing
LOCUS OF CONTROL
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THOSE GIVING HELP
Feeling
Feeling
Feeling
Feeling
Feeling
important
useful
powerful
gratified
happy
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THOSE NEEDING
HELP
Feeling unimportant
or inadequate
Feeling useless or
depressed
Feeling powerless
Feeling frightened
or embarrassed
Feeling sad or
angry
Phases of Helping
Relationship
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Orientation (professional and client to
each other)
Working (identification of the client’s
problem)
Termination (resolution of the client’s
problem)
Orientation Phase
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“Getting to know you” phase
Sets the tone
Introductions
Roles
Initiated by the nurse
Agreement/contract/goals
Orientation
Trust develops
Working Phase
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“Problem solving” phase
Attend to client’s needs
Nurse in role of teacher/counselor
Client actively participates
Gather further data
Facilitate change
Evaluate problems & goals
Termination/Resolution
Phase
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Review and summarize progress &
goals met/not met
Acknowledge feelings
Clients mostly seeking explanation
How will problem affect their lives?
What will need to be changed?
How will they cope?
Avoid
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Arguing
Minimizing
Challenging
Giving false
reassurance
Interpreting or
speculating on the
dynamics of the
client’s problems
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“Selling” client on
accepting treatment
Probing sensitive
areas
Participating in
criticism of any staff
member
Joining any attacks
led by the client
Attentive Listening Scale
-THINGS TO AVOID
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Lack of eye contact
Responding before the other finishes speaking
Finishing other people’s sentences
Talking so much that others cannot respond
Continuing to work while someone is talking to you
Repeat a point just made
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Allow your mind to wander during a conversation
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Active Listening
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STOP TALKING
Put the speaker at ease
Show that you want to listen
Remove distractions
Be empathetic
Be patient
Hold your temper
Avoid criticism & argument
STOP TALKING
Interviewing Techniques
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the purpose of the interview is
to obtain accurate & thorough information
begin with an explanation
use open-ended questions
(exception: use closed-ended to obtain
specific information)
Validating/Clarifying
Reflecting
Sequencing
Acknowledging feelings
Interviewing Techniques
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Validating & Clarifying
Reflecting & Paraphrasing
Sequencing
Acknowledging feelings
Sharing Observations
Effective Techniques
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as a professional nurse, you will spend
about half of your time asking
questions of clients and colleagues
excellent questioning/interviewing
skills are fundamental to nurses
Why, What, How?
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why do you need the information?
how will the information I am seeking direct
me in helping my client?
explain reasons in advance,
as this prepares clients for your line
of questioning
what will you ask?
how will you phrase your questions?
Who to Ask?
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if client is able to speak for themselves,
ask them
family perspectives may also be important
written consent may be required to question
concurrent/previous healthcare providers
be courteous and respectful
never forget client confidentiality
Communication Barriers
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“A barrier to communication is
something that keeps meanings from
meeting. Meaning barriers exist
between all people, making
communication more difficult than
most people seem to realize.”
(Ruel Howe)
Communication Barriers
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without realizing it, people typically interject
communication barriers into conversation
90% of the time
communication barriers trigger
defensiveness, resistance and resentment,
withdrawal, and feelings of inadequacy
they also decrease the likelihood of
finding a solution
Judging
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criticizing: making a negative evaluation of
persons, their actions or attitudes
putting down: stereotyping
diagnosing: analyzing why a person is
behaving the way he/she is
praising evaluatively: making a positive
judgment of person, actions or attitudes
Avoiding the
Other’s Concerns
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diverting: pushing the other person’s
problems aside through distractions
logical argument: attempting to convince
the other person with an appeal to facts or
logic without consideration of the emotional
factors involved
False reassurance: trying to stop the other
person from feeling the negative emotions
they are experiencing
Other Barriers
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ordering: commanding the other person to
do what you want
threatening: trying to control the other
person’s actions by warning of negative
consequences you will impose
moralizing: preaching, telling someone what
they should do
excessive/inappropriate questioning
Other Barriers
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closed ended questions, like “are you sorry
you did it?”
advising: giving the solution
Common Errors
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long winded buildup
(use KISS principle & be concise & focused)
the thunder stealer: jumping in with your
views & opinions before giving them
a chance
bombarding patients with questions
complicated medical termsdon’t use terms patients can’t understand
Common Errors
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offensive misuse of ‘why’ appears
threatening and aggressive
closed questions
being too abrupt
use of clichés
Blocks to Communication
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Failure to respect
client
Failure to listen
Minimizing feelings
Inappropriate
comments &
questions
Excessive questions
Clichés
Yes/no questions
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Probing
Changing the subject
Leading questions
Advice
Judgments
False reassurance
Giving
approval/disapproval
Blocks to Communication
Therapeutic Versus
Nontherapeutic
Communication
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Facilitates transformation of working
nurse-patient relationship
Relationship allows for adequate &
accurate data collection & assessment
Performed with & not for patient
Therapeutic Versus
Nontherapeutic
Communication
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NON-THERAPEUTIC
Hinders relationship formation
Prevents patient from becoming
mutual partner & relegates him/her to
passive recipient of care
Self-Disclosure
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Use self disclosure to
help clients open up
to you – not to meet
your own needs
Keep disclosures brief
Don’t imply that your
experience is exactly
the same as the client’s
Only self-disclose
about situations you
have mastered
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Monitor your own
comfort with
self-disclosure
Respect your client’s
needs for privacy
Remember that there
are cultural variations
in the amount of selfdisclosure considered
appropriate
Identify risks and
benefits of self
disclosure