Thursday, September 29, 2011

Therapeutic Communication

COMMUNICATION
- Human function that enables people to relate and interact with each other by means of a verbal and non verbal way.

MODES
Verbal         – spoken language
Non-Verbal – symbols, sign language


ELEMENTS OF COMMUNICATION
1. Stimulus – reason why people communicate, motivation with each other (object, ideas, feeling) referent
2. Message – idea, feelings and emotions
3. Sender – also known as encoder, one that sends the message
4. Channels – kinesthetic: tactile stimulus, visual: symbols, auditory: spoken language
5. Receiver – decoder
6. Feedback – answer to questions, whether receiver understood or not

FACTORS THAT AFFECT COMMUNICATION PROCESS

1. Ability of communicator – ability to speak, hear, see and comprehend stimulus
2. Perceptions – each has a unique trait, values, life experiences
3. Personal space – distance people prefer in interactions with one another
Four distances
a. Intimate
- Physical contact to 1 ½ feet characterized by body contact heightened sensation of body heat and smell, low vocalization
- Threatening to client
b. Personal
- 1 ½ feet to 4 feet
- Less overwhelming than intimate distance
- Usual distance between nurse and client
- Best distance
c. Social
- 4 feet to 12 feet
- Communication is non-formal
- Allows more activity and movement back and forth
- Often misused by nurse
d. Public
- 12 feet and beyond
- Individuality is lost
- Mass health education
4. Territoriality – concept of space and things that an individual considers as belonging to the self
5. Roles and Relationships
6. Time – events that precede and follow interactions
7. Environment – environment is comfortable, communication is more effective
8. Attitudes


























THERAPEUTIC COMMUNICATION and RATIONALE
Using silence
Accepting pauses or silences without interjecting any verbal response

Providing general leads
Using statements or questions that
     a. encourage client to verbalize
     b. choose a topic of conversation

Being specific and tentative
Statements that are specific rather than general and tentative rather than absolute

Using open ended questions
Specify only topic to be discussed and invite answers longer than one or two words

Using touch
Touch reinforces caring feelings; however the nurse should be sensitive to difference in attitude’s in every patient.

Restating/Rephrasing
Used when communication is rambling or when paraphrasing is difficult

Seeking clarification
Helping the client clarify an event situation or happening with respect to time

Clarifying time or Sequence
Helping the client clarify an event situation or happening with respect to time
Offering self
Suggesting ones presence, interest or wish to understand the client without making any demands that could make client comply to suggestion
Giving information
A simple and direct manner, specific factual information
Acknowledging
Giving recognition in a non judgmental way of
     a. change in behavior
     b. effort the client has made
     c. contribution to a communicator
Presenting reality
Helping client differentiate real from unreal
Focusing
 The focus may be an idea or a feeling. Directing ideas, feelings, questions or content back to clients to enable them to explore their own feelings
Reflecting
 Verifies meaning of specific words than overall meaning of a message

Summarizing and Planning
Perception checking
Stating the main points of discussion to clarify relevant parts discussed
Accepting pauses or silences without interjecting any verbal response





NON THERAPEUTIC COMMUNICATION
RATIONALE
Stereotyping


Agreeing and Disagreeing


Being defensive

Challenging


Probing


Testing

Changing topic

Unwarranted reassurance



Passing judgment


Giving common advice

Offering generalized and over simplified beliefs about groups of people

Akin to judgmental responses implies client is either right or wrong

Attempting to protect a person

Giving response that makes client prove their statement or point of view

Asking information chiefly out of curiosity rather than intent

Question than make a client admit something

 Directing communication into areas of self intent


Using clichés or comforting statements of advice as a means to reassure the client


Giving opinions and approving or disapproving response


Telling client what to do
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