therapeutic communication for B.SC Nursing 3rd year

1. COMMUNICATION
Introduction
Communication is the giving, receiving or
exchanging of information ,opinions or ideas
so that the message is completely understood
by everybody involved

2. DEFINITION
• Communication is the process of exchanging
information ,though ,ideas ,and feeling from
one individual to another.
• Communication is the process by which a
massage is passed from the sender to
receiver with the objective ,that the massage
sent is received and understood as intended.

3. Purpose of communication
• To transfer information between one to
another.
• To interpret and adopt policies in the
organization .
• To improve employer employee relationship.
• To recruit, select, train and develop the
personnel in the organization.
• To encourage participation in decision making

4. • To boost the group moral of the worker
• To ensure job satisfaction.
• to help in the grievance procedure and
disciplinary action .
• To prepare the personnel and public for a
change process.

5. Therapeutic communication
INTRODUCTION

6. DEFINITION
• In therapeutic communication the nurse direct
the communication toward the patient to
identify current health problem , plan
implement and evaluation the action taken.
• Therapeutic communication is defined as
communication strategies that support a
patient’s feeling of well being.

7. Purpose of therapeutic
communication
• Establish a therapeutic nurse patient
relationship.[establish- start a moral
relationship with somebody]
• Identify the most important patient’s need
• Asses the patient's perception of the problem
• Facilitate the patient's expression of emotion
• Implement intervention designed to address
the patient's need

8. • To identify client's strength and weaknesses.
• Clarify the area of conflict and anxiety.
• Promoting self care and independence.
• To develop trust .

9. Principles of therapeutic
communication
• Treat the client as an individual
• Accept the client as he is .
• Aware the total need of the client
• Emotional and involvement is essential .
• Consistency in behavior
• Encourage the client feeling
• Honest and open communication needed.

10. • Engage in active listening
• Establish trust and rapport.
• Sufficient time is provided to the client to
respond.
• When patient is uncomfortable do not prolong
the conversation.

11. THERAPEUTIC COMMUNICATION
TECHNIQUES
• LISTENING
• BROAD OPENING
• QUESTIONING
• RESTATING
• CLARIFICATION
• REFLECTION
• FOCUSING

12. • SHARING PERCEPTIONS
• THEME IDENTIFICATION
• SILENCE HUMORE
• INFORMING
• SUGGESTING
• CONFRONTATION
• ROLE PLAY

13. LISTENING
• It is the first rule of therapeutic nurse
relationship. the patient should be talking
more than the nurse during the interaction
listening is sign of respect and is powerful
reinforce[to make some thing stronger] .
Active listening involves all the nurse’s senses
eg. Maintaining eye contact and receptive
non verbal communication

14. BROAD OPENING
• BROAD OPENING – here the nurse is
encouraging the patient to select topic for
discussion. patient should be
welcomed to the communication with warmth
and respect .the patient should feel that nurse
is ready to listen eg. what are you thinking
about ? what shall we discuss today?
Domination of the interaction by the nurse or
rejecting the responses by the nurse result in
poor therapeutic relationship

15. QUESTIONING
• QUESTIONING - the nurse skillfully asks open
ended question [ that mean can not be
answered with yes or no, there is need to
longer response]during the initial admission
avoid asking too many personal questions in
one session eg. How come you stopped
taking your medication?

16. RISTATING
• Nurse is repeating of the main though the
patient has expressed it is also indicates the
nurse is listening to the patient .usually a part
of patient’s statement is repeated
• Eg. Your mother left when you were 5 yr. old?

17. CLARIFICATION
• Here the nurse make specific question to help
clear up a specific point . Patient verbalization
may not be clear when overwhelmed with
emotion , To make clear that which is vague or
maximize understanding between the nurse
and patient.
• Eg. I am not sure what you mean ,could you
tell me about it again.

18. with the help of reflection we can direct back
the client’s ideas, feelings, questions and
content.
Eg : You are feeling anxious and tense and it is
related to a conversation you had with your
husband last night?
REFLECTION

19. FOCUSING
• Focusing helps the patient expand a topic and
also helps in analyzing in detail .it helps the
patient talk about life experience and accept
the responsibility for improving them
Eg. I think you should talk more about your
relationship with your husband?

20. SHARING PERCEPTION
• It involves asking the patient to verify the
nurse’s understanding of what the patient is
thinking or feeling
Eg: “You are smiling, but I sense that you are
really very angry with me.”

21. THEME IDENTIFICATION
Themes are underlying [important but hidden]
issues or problems experienced by the patient that
emerge [to appear or come out from somewhere]
repeatedly during the course of the nurse-patient
relationship, like anxiety, depression.
“it sounds like that is very important to you, you
have mentioned it a very few times”

22. Silence:
• SILENCE – Lack of communication for a
therapeutic reason. Eg : Sitting with a client
and non-verbally communicating interest and
involvement .

23. HUMOR –
• HUMOR – The discharge of energy through
the comic enjoyment of the imperfect. That
gives a whole new meaning to the word
‘nervous’ , said with shared kidding between
nurse and the patient.

24. Informing:
Informing or giving information is nurse share
simple facts with the patient. This skill is use in
patient education like when to take medication,
necessary precautions and side effects.
“I think you need to know more about your
medication works”

25. SUGGESTING
• Suggesting is preparation of alternate ideas.
As a therapeutic technique, it is useful
intervention in the working phase of the
relationship. Suggesting or giving advice can be
non-therapeutic. Patient may take nurse’s advice
and still have an unsuccessful outcome, the
patient returns to blame nurse

26. CONFRONTATION
a fight or an argument
• Helping the patient become aware of
inconsistencies in feelings, attitudes, beliefs or
behaviors.
Eg. You say you have already decided what to
do, yet you are still talking a lot about your
options.

27. ROLE PLAY
• Role play is a technique that allows patient to
explore realistic situations by interacting with
other people in a managed way in order to
develop experience and trial different
strategies in a supported enviornment

28. THERAPEUTIC COMMUNICATION
TYPES .
• I ) Verbal Communication
• II ) Non – verbal communication

29. VERBAL COMMUNICATION
• Verbal communication means communicating
with words or spoken.

30. NON VERBAL

31. TYPES OF RELATIONSHIPS .
• SOCIAL RELATIONSHIP - social relationship
give us a way conceive social context, with the
help of social relationship we can fulfill our daily
needs
Ex. – friends, neighbors, coworkers,

32. • INTIMATE RELATIONSHIP An- intimate
relationship is a relationship between two
individuals committed to one another, caring for
and respecting each other . Those in an intimate
relationship usually react naturally with each
other . According to Erikson , the intimate
relationship focus the basis for marriage and
other partner-type relationships .

33. • THERAPEUTIC RELATIONSHIP The therapeutic
relationship between a healthcare professional
and a client ,it is a mean by which the therapist
and a client hope to engage with each other and
effect beneficial change in the client.

34. • HELPING RELATIONSHIP – it is an interaction
process in which the nurse fulfills their role by
using her professional knowledge and skill in
such a way that she is able to help the patient
physically, socially and emotionally.

35. COMPONENTS / ELEMENTS OF NURSE-
CLIENT RELATIONSHIP
• RAPPORT. – a friendly relationship in which
people understand each other very well
• EMPATHY. – the ability to imagine how another
person is feeling and so understand his /her mood.
• WARMTH. – the quality of being kind and friendly
• GENUINENESS - sincerity
• CONFIDENTIALITY.- usually this will mean keeping
things secret between the client and you .

36. THERAPEUTIC INTERPERSONAL
RELATIONSHIP – PHASES .
1. Pre-interaction phase = Explore self perception
of both Nurse and client.
nurse responsibility in pre – interaction phase
 to become well know about own feeling ,fear
and fantasies
Analyze professional strength and weakness
Collect information about the patient like
demographic data, occupational data
Prepare a plan based on the data before meeting

37. Problem found in preinteraction phase
• Anxiety
• Anger
• Depression
• Boredom
Nurse can take help of senior experienced nurse
to overcome anxiety ,analyze self and identify
the limitation.

38. Orientation phase
It is the first meeting of the nurse with her
client , in this phase the main goal of nurse
is to find out the cause of patient seeking help
Nurse responsibility in orientation phase
 nurse establish rapport ,gain trust and create
a familiar situation in which the patient accept
the nurse.

39. • Nurse initiate effective communication
• They collects all the data about client’s
feeling, emotion, strengths and weakness.
• The nurse identify major area of the problem
and plan for the interventions.
• The nurse discusses with the client how to
solve the problem .

40. Problem found in orientation phase
• both nurse and patient may have problem
accepting each other as a unique individual.
• They may have trust issues between them.

41. Working phase
• Most of the therapeutic interventional
activities carried out in this phase ,nurse and
patient act as a team to identify stressors of
the patient and promote the development of
insight.
Nurse responsibility in working phase
• gather more and more data of the patient to
explore the stressors.

42. • Let the patient understand his behavioral
change by evaluating himself
• The nurse can evaluate the problems and
redefine them.

43. Problem found in working phase
• Some times patient test the nurse
• Making an unrealistic goal can give frustration
to both nurse and patient
• Nurse live problem
• Transference
• Resistance

44. Termination phase
• It is the most important phase of the
relationship , the main aim of this phase is to
bring a therapeutic end to the termination
phase
Nurse responsibility of termination phase
• put reality of separation in front of the
patient

45. • Nurse and patient should mutually explore the
feeling ,emotion and related behavior
• Evaluate the effectiveness of therapy and
achievement of goal
• Discuss future plans for meetings if required

46. Problem found in termination phase
• Anger
• Punitive behavior
• Depression
• Nurse unwillingness to implement any plan

47. REVIEW TECHNIQUES OF IPR /. Johari
Window
• The Johari window is a technique to help
people better understand their relationship
with themselves and others it was created by
psychologist joseph Luft and Harrington
Ingham in 1955 .

48. Open area
Information about you that both
you and others know
Blind area
Information about you that you do
not know but others know
Hidden area
Information about you that you
know but others do not know
unknown area
Information about you that neither
you nor others know.

49. Need for johari window
• Self awareness
• Cordial relationship
• Improve communication
• Team development
• Personal development
• Group dynamics

50. Therapeutic impasse and its
intervention
• Therapeutic impasses are the block in the
progress of the nurse-client relationship.
Impasses provokes intense feelings in both the
nurse and the client, which may range from
anxiety and apprehension ( feeling of worry)
to frustration, love or intense anger. They arise
for a variety of reasons and may take many
different forms, but they all create blocks in
the therapeutic relationship

51. 5 IMPASSE
• Resistance
• Transference
• Counter transference
• Gift giving
• Boundary violation

52. Resistance
• Resistance is the patient ‘s attempt to remain
unaware of anxiety producing aspects within
the self , it Is a natural or learned reluctance
to avoidance of verbalizing or even
experiencing troubled aspects of self.

53. TRANSFERENCE
• It is an unconscious response of the patient in
which he experience feeling and attitudes
towards the nurse that were originally
associated with significant figures in his early
life

54. Counter transfarance
• It is a therapeutic impasse created by the
nurse
• It refers to nurse ‘s specific emotional
response generated by the qualities of the
patient
• In this case the nurse identifies the patient
with individual from their past and personal
need will interfere with therapeutic
effectiveness.

55. • The nurse’s unresolved conflicts about
authority ,sex, assertivness and independence
ten to create problems rather than solve them

56. Gift giving
• Receiving a gift from patient make the nurse
to inhibit independent decision making and
created a feeling of anxiety or guilt
• Gift is something of value is voluntarily offered
to another person ,usually to convey a
gratitude
• The timing of a particular situation ,the intent
of giving and the contextual meaning of giving
of the gift

57. Boundary violation
• It occurs when nurse goes outside the
boundaries of therapeutic relationship and
establishes a social, economic or personal
relationship with the patient.

58. Possible boundary violation related to
psychiatric nurse
• the patient takes the nurse out to lunch or
dinner
• Has difficulty in setting limit with patient
• Relates the patient to a friend or family
members
• Has sexual feeling towards a patient.

59. • Feels that she is the only one who
understands the patient
• Feel that other staffs are too critical or jealous
of her relationship with the patient.

60. INTERVENTIONS TO OVERCOME
THERAPEUTIC IMPASSES
• Nurse must have knowledge of impasses and
recognize behaviors.
• Nurses must examine their strengths ,
weaknesses, and values before they can
interact more appropriately with clients.
• Nurses must be open and clear about their
genuine[ real or true] reactions when clients
misperceive behavior .

61. • Limit setting is useful when clients act
inappropriately towards the nurse .
• Maintain open communication with his / her
supervisor[ most senior staff at the place of
work] ,who can assist the nurse in making
discharge plan of the patient.