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Therapeutic Communication is the interpersonal interaction between the nurse and the client during which the nurse

focuses on the specific needs of the client to promote an effective exchange of information between the nurse and the client. Goals 1. Encourage self-disclosure 2. Increase feelings of self-worth 3. Promote increased understanding (insight) 4. Encourage problem solving 5. Facilitate decision making Two Requirements for Therapeutic Communication 1. All communication must be aimed at preserving the self-respect of both individuals. 2. The communication of understanding should come before any suggestions or advice giving. Essential Components of Therapeutic Communication 1. Confidentiality- respecting the clients right to keep private any information about his condition. 2. Self-disclosure Revealing personal information about oneself to clients, such biographical information and personal ideas, thoughts and feelings. 3. Privacy and respect for boundaries Promoting privacy: -talking softly -drawing curtain between roommates -Turning on TV to muffle the conversation Therapeutic Communication Techniques 1. Using silence utilizing absence of communication 2. Accepting giving indication of reception; indicating that the nurse has and is willing to hear what the client says. Yes Uh hmm I follow what you said hear

3. Giving recognition acknowledging indicating awareness. Good morning, Mr S. I notice that you combed your hair 4. Offering self making oneself available; introducing self and identifying relationship. Ill sit with you awhile Ill stay here with you 5. Giving Broad Openings- allowing the patient to take the initiative in introducing the topic; using open-ended questions that provide opportunity for the client to introduce topic. Is there something you would like to talk about? What are you thinking about? Where would you like to begin? 6. Offering General Leadsgiving encouragement to continue. Go on. And then? Tell me about it. 7. Placing the Event in Time or in Sequenceclarifying the relationship of events in time.; assessing time frame and sequence of an event over time. Was this before or after? When did this happen? 8. Making Observationsverbalizing what is perceived; verbalizing what nurses sees in clients appearance and behaviors You appear tense. I notice that youre biting your lips. It makes me uncomfortable when you 9. Encouraging Description of Perceptions asking the patient to verbalize what he perceives; having the client describe his/her view of an event or experience. Tell me when you feel anxious What is happening What does the voice seem to be saying 10. Encouraging Comparison asking that similarities and differences be noted. Was this something like? Have you had similar experience? 11. Restating repeating the main idea expressed. Patient: I cant sleep. I stay awake all night Nurse: You have difficulty sleeping? 12. Reflecting directing back to the patient questions, feelings and ideas. Patient: Do you think I should tell the doctor? Nurse: Do you think you should? 13. Focusing concentrating on single point This point seems worth looking at more closely. 14. Exploring delving further into a subject or idea Tell me more about that.. Would you describe it more fully? 15. Giving Information- making available the facts that the patient needs. My name is. Visiting hours are

16. Seeking Clarification seeking to make clear that which is not meaningful or that which is vague; trying to clear up confusion about events or people. Im not sure that I follow. 16. Seeking Clarification seeking to make clear that which is not meaningful or that which is vague; trying to clear up confusion about events or people. Im not sure that I follow. What would you say is the main point of what you said? 17. Presenting Reality offering for consideration that which is real; giving a realistic explanation of what the client says or hears. I see no one else in the room Your mother is not here, Im a nurse 18. Voicing Doubt expressing uncertainty as to the reality of the patients perception; gently questioning the reality of the clients perception. Isnt that unusual? Really? 19. Seeking Consensual Validation searching for mutual understanding for accord in the meaning of the words; two or more people achieving agreement of interpretation of an event, behavior or issue. Tell me whether my understanding of it agrees with yours.. 20. Verbalizing the Implied voicing what the patient has hinted at or suggested. Patient: I cant talk to you or to anyone. Its a waste of time. Nurse : Is it your feeling that no understand you? 21. Encouraging Evaluation asking the patient to appraise the quality of his experience. What are your feelings in regard to 22. Attempting to translate into feelings- seeking to verbalize the feelings that are being expressed only indirectly. Patient: Im dead Nurse: Are suggesting that you feel lifeless? Or is it that life seems without meaning? 23. Suggesting Collaboration offering to share, to strive, to work together with the patient for his benefit. Perhaps you and I can discuss and discover what produces your anxiety 24. Summarizing organizing and summing up that which has gone before. Have I got this straight? Youve said that.. 25. Encouraging Formulation of Plan of Action- asking the patient to consider kinds of behavior likely to be appropriate in further situations; planning appropriate resolution of a problem in graded steps. Deterrents to Therapeutic Communication 1. Reassuring indicating that there is no cause for anxiety; trying to make the client feel better superficially and not to worry or be anxious. Everything will be alright 2. Giving Approval sanctioning patients ideas or behavior.

Thats good. 3. Rejecting refusing to consider or showing contempt for the patients ideas or behavior. Lets not discuss.. 4. Disapproving denouncing the patients behavior or ideas. Thats bad. 5. Agreeing indicating accord with the patient. Thats right 6. Disagreeing opposing the patients idea. Thats wrong 7. Advising telling the patient what to do. I think you should. 8. Probing persistent questioning of the patient of unrelated topics. Now tell me about. 9. Challenging- demanding proof from the patient. But how can you be the president of the US? 10. Testing appraising the patient degree of insight. Do you know what kind of hospital is this? 11. Defending- attempting to protect someone or something from verbal attack. This hospital has fine reputation. 12. Requesting an explanation asking the patient to provide the reasons for thoughts, feelings, behavior, and events, demanding the rationale for an action, thought or feeling. Why? 13. Indicating the existence of an external source attributing the source of thoughts, feelings, and behavior to others or to outside influences. Who told you that you are Jesus? 14. Belittling feelings expressed- misjudging the degree of the patients discomfort. Patient: I have nothing to live forI wish I were dead. Nurse: Everybody gets down in the dumps. Or Ive felt that way sometimes 15. Making stereotyped Comments offering meaningless clichs, when client or sad or upset. Nice weather were having Its for your own good 16. Using denial refusing to admit that a problem exists. Patient: Im nothing. Nurse: Of course youre something. Everybody is something 17. Interpreting seeking to make conscious that which is unconscious, telling the patient the meaning of his experience. Unconsciously you are saying. 18. Introducing unrelated topic changing the subject Patient: I like to die. Nurse: Did you have visitors this weekend?