Therapeutic Communication

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Therapeutic communication is an effective communication, purposeful and goal directed.  It is composed of verbal or non-verbal techniques that the nurse uses to focus on the patient and the patient's problems or needs. It promotes understanding and helps in establishing a constructive relationship between the nurse and patient. (HELPING RELATIONSHIP)


Helping Relationship
Helping is a growth-facilitating process that strives to achieve two basic goals (Egan, 1998)

1. Helps patients manage their problems in living more effectively and develop unused or underused opportunities more fully.
2. Helps patients become better at helping themselves in their every day lives.

GOALS OF THERAPEUTIC COMMUNICATION

1.  Develop Trust

• be honest when answering questions
• Respond promptly to call bell

2.  Show Caring

• Greeting patient by using name
• Knock the door before entering
• Offering drinks before asked

3.  Obtain or Provide Information

• Getting information from patient about health status fro accurate assessment and plan of care
• provide information throughout patient hospitalization

4.  Explore Feeling

• Help patient to express his or her feeling of fear or anxiety
• Guide patient to identify suitable acceptable solution

BEHAVIOURS OR ELEMENTS IN THERAPEUTIC COMMUNICATION

1. Caring

• Basic nurse-patient relationship
• There are four steps in caring: 1. make eye contact; 2. listen carefully; 3. respond to patient; 4. empower your patient..

2.  Warmth

• make patient feel relaxed and welcomed
• touch, holding patient's hand is method showing warmth

3.  Active Listening

• Listening to the spoken word and attention to non-verbal communication

4.  Genuinenes

• The nuse must be honest about personal feeling

5.  Empathy

• Understand another person's feeling

6.  Acceptance and respect

• accept client's value, belief and attitude
• respect client by addressing Mr, Mrs, or Madam

7.  Self Disclosure

• sharing of thoughts, expectations, feelings and ideas
• not sharing of personal problems

TECHNIQUES OF THERAPEUTIC COMMUNICATION

1.  Using Silence

• accept pause or silences
• can last for several seconds or minutes

2.  Providing general leads

• Using statement or question that encourage patient to talk

3.  Being Specific

• Make specific statement rather than general. E.g. "Rate your pain on a scale of 1 to 10" (specific)
• "Are you in pain?" (general statement)

4.  Using Open-ended question

• Specific to the topics and patient's answer will  be longer than one or two words..
• E.g. "Tell me about..."; "....I'd like to hear more about that."

5.  Using touch

• Provide reinforcement and caring feelings
• E.g.  putting an arm on client's shoulder

6.  Restating or paraphrasing

• Listen actively to patient then repeat those messages
• E.g. client: I have problem talking to others.
• Nurse: You find it difficult to talk to others..

7.  Seeking clarification

• making client message more understandable
• E.g. "Would you please say that again?"

8.  Perception Checking or seeking consensual

• Verifying the meaning of specific words rather than overall meaning of message
• E.g. Client: "My husband never give me present."
• Nurse:  "You mean your husband never gives you a present for your birthday?"

9.  Offering self

• Wish to be with patient without any demands or condition
• E.g.  "I'll stay with you until your daughter arrives."

10.  Giving Information

• Giving simple, direct, factual information
• E.g. "Your surgery is scheduled at 11 am."
• "I don't know the answer but I'll find out from the doctor."

11.  Acknowledging

• Giving recognition
• E.g. "You walked twice as far today with your walker."

12.  Clarifying time or sequence 

• Help the client clarify an event, situation or time
• E.g. Client:  "I vomited twice today."
• Nurse:  "Was that after breakfast?"

13.  Presenting reality

• Help client differentiate real and unreal
• E.g. "Your magazine is in the drawer.  Not been stolen."

14.  Focusing

• Nurse must wait until the client finishes his or her statement
• E.g. "Sounds like you are worried about how she copes."

15.  Reflecting

• Directing ideas, feelings, thoughts to patient in order to explore ideas..

16.  Summarizing and planning

• stating the main points
• useful in health education
• E.g. "During the first half hour we have talked about...Tomorrow we will explore this further".

Excerpt from lecture notes...

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