This document discusses therapeutic communication and interpersonal relationships in nursing. It outlines the goals and functions of nurse-patient communication, including allowing patients to express themselves, clarifying issues, and modifying behaviors. It describes different types of communication like verbal, nonverbal, written and meta communication. Elements of the communication process and characteristics of therapeutic communication are explained. The document also covers dynamics of the nurse-patient relationship and techniques to facilitate therapeutic communication.

1. THERAPEUTIC
COMMUNICATION AND
INTERPERSONAL
RELATIONSHIP
Unit 5

2. Review communication process factors
affecting communication
• INTRO: communication refers to the
reciprocal exchange of information, ideas,
belief feelings and attitudes between persons
communication is very significant in nursing.
• Def: the nurse directs the communication
towards the patient to identify his current
health problems, plans implements and
evaluates the action taken.

3. Goal of nurse pt comm.
1. Self –Realization, self acceptance and an
increased genuine self-respect.
2. A clear sense of personal identify and an
improved level of personal integration.
3. An ability to form intimate interdependent,
interpersonal relationship with a capacity to
give and receive love.

4. Function of a nurse in therapeutic
nurse pt interaction
1. Allows the pt to express his thoughts and
feelings and relates these to observed and
reported interactions.
2. Clarifies the areas of conflict and anxiety.
3. Identify the maximizes the patients ego
strengths and encourages socialization and
family relatedness.
4. Corrects and communication problems.
5. Modifies adaptive behavior patterns.

5. purpose
1. Environmental changes from home to
hospital: they desire protection, comfort rest,
and freedom from demands of their usual
home and work environments.
2. Nurturance: they wish someone to care for
them, cure their illness and make them feel
better.
3. Control: they are aware of their destructive
impulses to themselves or others but lack
internal control.

6. Cont..
4. Psychiatric symptoms: they describe
symptoms of depression nervousness or
crying spells. They knew they need psychiatric
help and actively want to help themselves.
5. The nurse help the pt to cope with the
present problems.
6. The nurse assists the patient to identify
emerging problems realistically.
7. The nurse help the pt to try out new
alternative for his or her problems.
8. The nurse help the pt to understand the
problems.

7. types
• Verbal communication: it involves the spoken
word. It is an exchange using the elements of
language. Taken alone verbal communication.

8. Types of
communication
verbal meta
Written/
nonverbal

9. Non verbal
• Includes everything that doen’t involve the
spoken or wirtten words, including all of the
five senses, it is often uncounsciously
motivated and may more accurately indicates
the person’s meaning than the words being
spoken.

10. Types of non verbal behaviours
1. Vocal cues or paralinguistic cues
2. Action cues
3. Object cues
4. touch

11. Meta communication
• It is an implicit but integral part of the
message and is an interpersonal bridge
between verbal and nonverbal components
communication.
• How the message should uinderstand by the
receiver. E.g the message ‘’you look
fresh&lovely today’’ is conveyed with wrinkles
of the fore head.

12. Elements of communication
1. Sender-the sender:
• it is the orginator of the message.
• To be an effective communicator he must
know his objectively clearly defined his
audience it interest and needs, his message,
channels of communication, his professional
ability and ties abd limitations.

13. Cont..
2. Receiver: the receiver is the target of the
communiocation and must be able to
understand or decode the message. This can
be a single person or a group.

14. Cont..
• 3. message: a message is the information
which the communicator transmits to the
receiver, to receive, understand ,accept and
act upon. It may be in the form of words,
pictures, or signs. A good message must be.
• Meaningful,accurate clear understands timely
and adequate fitting the audience, intersting.

15. • 4. channels of com;
• interpersonal comm-face to face
communication
• Mass media- TV, radio printed media,
phamplets
• Folk media-traditional folk media folkdance
singing, dramas.

16. Therapeutic communication
• According to berlo, under 4 headings as the
SMCR model
• S- is source
• M- stands for message
• C- channel
• R- receiver

17. Characteristics of therapeutic
communication
1. Response dimension
• Genuiness
• Respect
• Emapthtic
• understanding
• Concretness
2.Action dimension
Confrontation,immediacy,nurse self disclosure,
catharsis, role play

18. Ethics and responsibilities
• A moral principle exists that involve a moral
obligations or duty to do or to refrain from
doing something that is within the power of the
person to do or is such that the person can do
other wise.
• Some source of responsibility is involved as
well as a source or reward, praise, or
punishment ro responsible actions
• The cause of the behaviour is internal to the
individual and he or she is not complelled to
act by others.

19. Com.with individuals and in groups
• Non verbal com. With individuals:
• Body language is a form of nonverbal
communication, consisting of body pose,
gestures, eye movements and paraliuistic cues
e.x tone of voice and rate of speech humans
send and interpret such signals unconsciously.
• Human com. Consists of 93% body language
and paralinguistic cues while only 7% of com.
Consists of words themselves.

20. Physical expression
• Like waving pointing touching and slouging are
all forms of nonverbal communication. The study
of body movmeent and expression is known as
kinesics.
• Human move their bodies when communicating
because as research as shown it helps ease the
mental effort when communication is difficult.
• Ex, hands of knees indicates readiness
• Hands on hips impatience
• Lock your hands behind your back self control
• Locked hands behind head states confidence.

21. Body language and space
• Interpersonal space refers to the psychological bubble
that we can imagine exists when someone is standing
way too close to us.
• Research has revealed tht in north america there are
four different zones of interpersonal space.
• the first zone is called intimate distance and ranges from
touching to about eigtheen itches apart.
• Intimate distance is the space around us that we reserve
for lovers children as well as close family members and
friends.
• the second zone is called personal distance and begins
about an arm’s length away starting around eighteen
inches from our person and ending aout four feet away.

22. Language difficulties
• Misunderstandings in communication are
common because of the many different ways
people use language.
• Though there is no right or wrong way to
communicate, avoiding language barriers such
as jargon, bypassing and offensive language
may prevent misunderstnadings in group or
interpersonal discussions.

23. Therapeutic communication
techniques
• Listening is an active process of receiving
information and examing reaction to the
messages reveived.
• It is not simply hearing.
• It is essential to reach any understanding of
the patient.
• It is the first rule of therapeutic-nurse
relationship.active listening involve all the
nurse’s senses.
• Ex maintaining eye contact

24. Cont..
• Broad openings: here the nurse is encouraging
the patient to select topics for discussion.
Patient should be welcomed to the
communication with warmth and resopect.
• Open-ended questions result in fuller more
revealing answers.
• Ex what are u thinking about?
• can u tell me more about that?

25. Cont..
• Questioning:the nurse skillfully asks open-
ended questions during the intial admission.
Interviewing skills are necessary to avoid
asking too many personal questions in one
session. Questions should be to active
relevance and depth questions.
• How come u stopped taking ur medication?

26. Cont..
• Restating: nurse is repeat of the main thought
the patient has expressed.
• It also indicates that the nurse is listening
validating, reinforcing or calling attention to
what has been said.
• Ex your mother left you when you were 5 year
old?

27. • Reflection: nurse is directing back the patients
ideas, feeling questions or content.
• Reflection lets the patients know that the
nurse has heard what was said and understand
the content.
• it signifies understanding empathy interest and
respect for the patient other techniques may
not represent empathetic understanding
• You are looking sad and tense.

28. • Focusing : helps the patient expand to a topic of
importance and also helps in analyzing in detail.
• It helps the patient talk about life experiences or
problem areas and accepts the responsibility for
improving them.
• If the goal is to change thoughts feelings or belief
the patinet must first identify and down them.
• I think u should talk more about ur relationship
with ur husband?

29. • Sharing perceptions: it involves asking the
patient to verify the nurse’s understanding of
what the patient is thinking or feeling.
• Ex: nurse is interviewing an alcoholic patient
• Patient: my wife and children are so good.
They love me but I do not know what
happended to me I can’t care them I can’t stop
drinking.
• Nurse: you seem to be very disappointed with
your drinking am right about that?

30. • Theme identification: are underlying issues or
problems experienced by the patient that
emerge repeatedly during the course of the
nurse patient relationship like anxiety
depression
• It sounds like that is very improtant to you.
You have mentioned it a very few times.

31. • Silence:the nurse use lack of verbal
communication for a therapeutic reason.
• It allows the optient to think and gain insights.
Silence on the part of nurse has verying
effects depending on how the aptient perceives
it.
• To a vocal patient silence on the part of nurse
may be welcome but with a depressed or
withdrawn patient the nurse silence may
convey suport understanding and aceptance.

32. • Humour : is basic part of our personality and
has a place in theapeutic nurse-patient
relationship .
• It is the discharge of energy through the
comedian enjoyment of imperfect.
• If may be helpful with a patient experincing
mild to moderate anxiety humour should be
consistent with social and cultural values.

33. • Informing: or giving information is nurse
shares simple facts with the patient. This skill
is use in patient education .like when to take
medication, necessary precautions and side
effects.
• Think you need to know more about your
medication works informing should not fall in
to giving advice.

34. • Suggesting: is the presentation of alternate
ideas as a theapeutic technique it is useful
intervention in the working phase of the
relationship.
• Suggesting or giving advice can be non-
therapeutic.
• Patient may take nurse advice and have an
unsucceessful outcome, the patient reurns to
blame nurse.

35. • Confrontation: involves anger amnd aggression. The
therapeutic dimension is assertiveness rather than
aggression.
• Confrontation is an attempt by the nurse to make the
patient aware of incongruence in is or her feelings,
attuitudes, beliefs and behaviours.
• It may also help in discovery of ambivalent feelings in
the patient.
• the nurse must be ready to work with the patient
through the crisis after confrontating the patient.
• With out thuis commitiment the confrontation lack
therapeutic potential and may damage nurse patient
relationship

36. • Role playing: involes acting out a particular
situation.
• It increases patients insight in to human
relations can deep the ability to see the
situation from another persons point of view.
• Roleplaying can be used for attitude change
and to promote self-awareness.

37. Touch therapy
• Touch is a powerful communication tool.
• It can elicit both negative and positive reactions,
depending on the people involved and the
circumstances of the interaction.
• it is a very basic and primitive form of
communication and the appropriateness of its use
is culturally determined.
• State of mind is vital for any person who is
thinking about getting therapeutic touch or TT
treatments.

38. Categories of touch
1. Functional- professional
2. Social-polite
3. Friendship-warmth
4. Love-intimacy
5. Sexual-arousal

39. Therapy
• The therapist uses a light touch or holds his/her
hands above the body;
• the client is usually seated in a massage.
• the therapist uses mediation to identify the energy
field around a patients body and then to center
and strengthen the connection to the patients
energy field using their hands.
• The therapist does this by scanning the body from
head to toe. Their hands are typically held in a
horizontal position, side by side with their thumbs
touching and their palms facing the patient in a
butterfuly-like shadow.

40. Benefit
1. A sensation of enveloping warmth from the
therapist’s touch
2. A totally relaxed state
3. The feeling of vibrations of energy coursing
through the entire body
4. Intense euphoruia and feelings of peace
5. A kaleidoscope of color and beautiful light
6. An intense sense of clairty, inner peace and well-
being.

41. Barrier of communication with specific
reference to psychopathology
• Language :the most important communication
barrier is language.
• Many clients speak english as a second
language and a smaller proportion are hearing
imparied or deaf.
• These groups present nursing withn the
greatest challenge.
• Avilable tp translate important information.

42. Cultural considerations
• Specific cultural considerations can provide
important insight into effective communication.
• expolitical religious or thnic presecution or to
obtain better economic or educational
opportunities indiviudals have left their countries
of origin.
• Different cultures use language differently. Ex
medical personnel havea jargon or their own
• Clients may not understand PET scan or
boderline.

43. Age and development level
• Age differences may pose communication
problems. With aging can come loss of hearing
eyesight, or cognition. In addition the elderly
hold values that may be different than those
of younger people.
• Children do not think abstractly and reaching
their level of understanding reqwuires a more
concrete apporach.

44. Level of health
• An individual with depression may speak little
because of the level of illness, and initiating
and maintaining communication may be
difficult. Those with mania may have unusual
speech patterns, so the nurse may need to set
limits. The client who has paranoia may be
suspicious and difficult to bond with, whereas
clients who are delirious need simple, short
sentences repeated to them to communicate.

45. Knowledge level
• Communication is affected by the amount and
kinds of facts the client has at hand. The nurse
assesses the clients fund of knowledge and
educational background at the time of
admission. The knowledge level will dictate
both teaching needs and the method of
instruction. The nurse also speaks in words
that are commensurate with the clients level of
understanding.

46. Time
• Counseling takes time, and the need to hurry
blocks communication. Therefore, plan to
interview when neither you nor the patient is
pressured. Hectic times to avoid include
changes of shift, visitations, doctors rounds or
when other appointments are pending.

47. Day dreaming or self talk
• People speak at a rate of 125 to 150 words a
minute. However they have he ability to listen
to 800 words per minute. Therefore as the
client talk, the nurses mind may wander. Be
sure to constantly attend to what the client
says, to control personal thoughts and to stay
alert.

48. The nurses or clients feelings
• Whenever the nurse or client becomes anxious
communication changes. Talking about or
listening to disturbing experiences or
information is uncomfortable.

49. Unhelpful communication techniques
• Nurses overcome responses that halt
communication by being aware of the
approach. Most of these responses consist of
statements the change the focus. Finalize the
interview or result in the clients feeling
inadequate threatened or confused.

50. Therapeutic attitudes
• General attitude toward the mentallt ill
• The community responds to the mentally ill through
denial, isoration and rejection. These are also alack of
understanding of mental illness as any other illness, and
a lack of trendency to reject both the patients and those
who treat them.
• Mentally ill are viewed as people with mnop capacity
for understanding
• People feel mental illness cannot be cured, and even if
the patient gets better, complete physical rest is
considered essential.
• The mentally ill are by and large perceived as
aggressive violent and dangerous.

51. Cont..
• An individuals values and personal beliefs
affect his attidude about mental illness, the
mentally ill and treatment of mental ilness.
There still exists a stigma surrounding
individual who need or use psychiatric mental
health services. The need continues for public
education to modify or alter muisconceptions
about mental illness and people with mental
disorders.

52. Dynamic of therapeutic nurse patient
relationship
• Introduction: nurse patient relationship is
significant psychiatric nursing too. The
objective of psychiatric nursing is- the
promotion for mental health, prevention of
mental illness and care and rehabilitation of
the patient with mental illness.

53. Types of relationship
• Social relationship: it is just happens with
mutual interests for satisfying needs of each
other.
• Intimate relationship it is a relationship
between two individuals committed to one
another, caring for and respecting each other
partner type.

54. Therapeutic relationship
• Definition: one to one relationships is the end
result of a series of planned purpose
interaction between two human being, a
nurse and a patient.

55. purposes
1. It is a therapeutic goal directed relationship
between the nurse and the patient.
2. To bring insight and behavioural changes.
3. To develop mutual growth between two
indiviudals.
4. To promote self realization, self acceptance and
an inceased genuine self respect self identify
and personal integration.
5. It is the central medicine through which all
psychiatric care is provided to care the mental
illness.

56. Cont..
1. To identify appropriate nursing approaches.
2. to achieve developmental goals
3. Provide comfort, protection rest and freedom
from demands of thire unual home and work
envidonment
4. To nurture the clients illness
5. Nurse assist the client identify present
problems realistically and tryout new
patterns of behaviour.

57. principles
1. Treat the client as an indivdual
2. Accept the client as he is
3. Aware the total needs of the client
4. Nurse understands herself and clients needs
motives desires, feelings and tears.
5. Emotional and involvemtn is essential
6. Objectivity has to be manintained
7. Consistency in behaviour
8. Set approximate limits and goals
9. Honest and open communication his needed.
10.Engage in active listening

58. Therapeutic use of self gaining self
awareness
• Self awareness: it is our important which a nurse
must identify herself himself. Self awareness
includes self-concept, beliefs and values and life
experiences.
• Belief and values with which a nurse comes will
affect the way she takes care of her patient or
develop IPR. If she values the human life and
believes in respecting the person as a human
being she will give individualized care to the
patient.

59. Campbell 1980 has identified a holistic
nursing model of self awareness
1.Psychological: includes knowledge of
emotions, motivations, self concept and
personality. Being psychologically self-aware
means being sensitive to feelings and outside
events that affect those feelings.

60. Cont..
• 2.physilogical includes the knowledge of
personal and general physiology, as well as
bodily image and physical potential.
• 3.environmental : consists of social-cultural
environment relationships with ithers and
knowledge of the relationship between huma
and nature.

61. Cont..
• 4. philosophical: it includes sense of life
having meaning together these components
provide a model that can be used to promote
the self-awareness and self growth of nurses
and for patient for whom they care.

62. Attitude towards the patient
• Attitudes the nurse has developed over the
course of a lifetime may determine the nurse’s
behavior towards the client.
• Rapport it is defined as a relationship of
mental sympathy and understanding
especially between patient and therapist the
essential qualities for developing rapport are
warmth, genuineness, and empathizing ability.

63. Johari window
• The johari window is a model that is used to
describe human interaction. It is named after
the first names of its inventors Joseph luft and
harry Ingham.

64. Johari window
OPEN
BLIND
HIDDEN
Not known to others
UNKNOWN
Known to others

65. First quadrant is the open area
• which consists of information that is open to
the public and easy for one to reveal. The first
pane, the arena contains things that I know
about myself and about which the group
knows. Characterized by free and open
exchanges of information between myself and
others this behavior is public and available to
everyone.

66. • The next box is the blind area also recognized as
things others know about us but we don’t’ know
about ourselves. The second pane, the blind spot
contains information that I do not know about
myself but of which the group may know. As I
begin to participate in the group, I am not aware
of the information I communicate to the group.
The people in the group learn this information
from my verbal cues, mannerisms the way I say
things or the style in which I relate to others

67. • The third quadrant is the hidden area is more
personal information that we know about
ourselves, but we chose not to share this
information with others. Pane three the ‘’facade
or hidden area. Contains information that I know
about myself but the group does not know. I keep
these things hidden from them. I may fear that if
the group knew my feelings, perceptions and
opinions about the group or the individuals in the
group, they might reject attack, or hurt me.

68. • The final and fourth quadrant is the unknown
area that is information that you and no one else
has yet to discovery about yourself. The johari
window can allow for one to have eye opening
experiences about themselves. The fourth and lat
pane, the unknown contains things that neither I
nor the group knows about me. I may never
become aware of material buried far below the
surface in my learn other material. Though,
through a feedback exchange among us.

69. Therapeutic nurse-patient relationship its
phase conditions essential to development
of a therapeutic relations
• A vital characteristic of nurse patient relationship
is the sharing of behaviors, thoughts and feelings.
(Peplau) 1962
• The task of the relationship have been
categorized into 4 phases:
1. The Pre interaction phase
2. The orientation
3. The working phase
4. The termination phase

70. The pre interaction phase
• Begins before the nurse’s first contact with the
patient. Here preparation for the first encounter
with the client. It begins before the nurse’s first
contact with the patient. A common fear of nurse
related to the stereotype of psychiatric patient as
violent. Other fear is related to nurses questioning
their own mental health status. Nurses may fear
mental illness and worry that exposure to
psychiatric patients might cause them to lose their
own needs.

71. task
1. Obtaining available information from case
sheet, chart, significant others, and other
health team members.
2. Initial assessment is begun
3. Prepare self for working activity

72. The orientation phase
• The introductory contract between client and
nurse first meet. It is the introductory phase
that the nurse and patient first meet. One of the
nurses concerns is to find out why the patient
sought help and whether it was voluntary.

73. elements
1. Name of the individual
2. Roles of nurse and patient
3. Responsibilities of nurse and patient
4. Expectations of nurse and patient
5. Purpose of the relationship
6. Meeting location and time
7. Conditions for termination
8. confidentiality

74. Working phase
• Most of the therapeutic work is carried out
during the working phase. The nurse helps the
patient to master anxieties increase
independence and self-responsibility and
develops constructive coping mechanisms.
Actual behavior change is the focus of this
phase.

75. task
1. Maintaining the trust and rapport
2. Promoting the clients insight and perception
of reality
3. Develop realistic self concepts and promote
self confidence.
4. Develop a plan of action implement the plan
and evaluate the results of the plan.
5. Help client to change her/him dysfunctional
behavior.