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Wednesday, April 1, 2009

Therapeutic Communication Techniques for Nclex, NLE, CGFNS Exams

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NurseReview.Org - Therapeutic Communication Techniques - Presentation Transcript

1. THERAPEUTIC COMMUNICATION TECHNIQUES TECHNIQUE EXAMPLES RATIONALE Accepting – indicating reception; “Yes” An accepting response indicates the nurse has heard recognizing the other person without “I follow what you said” and followed the train of thought. It does not inserting own values or judgments; Nodding indicate agreement but is nonjudgmental. Facial may be verbal or nonverbal; with or expression, tone of voice, and so forth also must without understanding convey acceptance or the words will lose their meaning. Active listening – an active process of Maintaining eye contact and Nonverbally communicates nurse’s interest and receiving information and examining receptive nonverbal acceptance to client one’s reaction to messages received communication Neutral response - Showing interest Being nonjudgmental. Refrain from showing negative and involvement without saying emotions of disapproval, surprise, anger, dislike, anything else etc. Empathy - Experiencing another's feeling temporarily; truly being with and understanding another through active listening Eye contact - As appropriate to the client's culture Offering self – making oneself available “I’ll sit with you awhile.” The nurse can offer his presence, interest, and desire “I’ll stay here with you.” to understand. It is important that this offer is “I’m interested in what you think.” unconditional, that is, the client does not have to respond verbally to get the nurse’s attention. Humor – discharge of energy through “This gives a whole new meaning Can promote insight by making conscious repressed comic enjoyment of the imperfect to ‘just relax’.” material, resolving paradoxes, tempering aggression, revealing new options, and is a socially acceptable form of sublimation Making observations – verbalizing what “You appear tense.” Sometimes clients cannot verbalize or make the nurse perceives “Are you uncomfortable themselves understood. Or the client may not be when…?” ready to talk “I notice you’re biting your lip.” Silence – absence of verbal Nurse says nothing but continues Silence often encourages the client to verbalize, communication, which provides time to maintain eye contact and provided that it is interested and expectant. Silence for the client to put thoughts or feelings conveys interest. gives the client time to organize thoughts, direct the into words, regain composure, or topic of interaction, or focus on issues that are most continue talking important. Much nonverbal behavior takes place during silence, and the nurse needs to be aware of the client and his own nonverbal behavior. Broad Openings – allowing the client to “Is there something you’d like to Broad openings make explicit that the client has the take the initiative in introducing the talk about?” lead in the interaction. For the client who is hesitant topic Where would you like to begin?” about talking, broad openings may stimulate him or her to take the intiative. Formulating a plan of action – asking “What could you do to let your It may be helpful for the client to plan it in advance the client to consider kinds of behavior anger out harmlessly?” what he or she might do in future similar situations. likely to be appropriate in future “Next time this comes up, what Making definite plans increases the likelihood that situations might you do to handle it?” the client will cope more effectively in a similar situation. Theme Identification – underlying “I’ve noticed that in all the Allows nurse to best promote client’s exploration and issues or problems experienced by relationships that you have understanding of important problems client that emerge repeatedly during described, you’ve been hurt or nurse-client relationship rejected by the man. Do you think this is an underlying issue?” Giving information – making available “My name is…” Informing the client of facts increases his knowledge facts that the client needs “Visiting hours are …” about a topic or lets the client know what to expect. “My purpose in being here is…” The nurse is functioning as a resource person. Giving information also builds trust with the client. Giving recognition – acknowledging, “Good morning, Mr. S…” Greeting the client by name, indicating awareness of indicating awareness “You’ve finished your list of change, or noting efforts the client has made. things to do.” Shows that nurse recognizes the client as an “I notice that you’ve combed your individual. Such recognition does not carry the hair.” notion of value, that is, of being “good” or “bad”. Self disclosure - Sharing personal information at an opportune moment to convey understanding or to role model behavior
2. Clarification - Putting into words vague ideas or unclear thoughts of the client. Purpose is to help nurse understand, or invite the client to explain Encouraging comparison – asking that “Was it something like…?” Comparing ideas, experiences or relationships brings similarities and differences be noted “Have you had similar out many recurring themes. The client benefits from experiences?” making these comparisons because he or she might recall past coping strategies that were effective or remember that he or she has survived a similar situation. Encouraging description of “Tell me when you feel anxious.” To understand the client, the nurse must see things perceptions – asking the client to “What is happening?” from client’s perspective. Encouraging the client to verbalize what he or she perceives “What does the voice seem to be describe fully may relieve the tension the client is saying?” feeling, and he might be less likely to take action on ideas that are harmful or frightening. Exploring – delving further into a subject “Tell me more about that.” When clients deal with topics superficially, exploring or idea “Would you describe it more can help them examine the issue more fully. Any fully?” problem or concern can be better understood if “What kind of work?” explored in depth. If the client expresses an unwillingness to explore a subject, however, the nurse must respect his wishes. Focusing – concentrating on a single “This point seems worth looking The nurse encourages the client to concentrate his point; Picking up on central topics or at more closely.” energies on a single point, which may prevent a \"cues\" given by the client “Of all the concerns you’ve multitude of factors or problems from overwhelming mentioned, which is most the client. It is also a useful technique when a client troublesome?” jumps from one topic to another. General leads – giving encouragement “Go on.” General leads indicate that the nurse is listening and to continue “And then?” following what the client is saying without taking “Tell me about it.” away the initiative for the interaction. They also encourage the client to continue if he is hesitant or uncomfortable about the topic. Incomplete sentences - Encouraging \"Go on…\" the client to continue with phrases “And…” Placing event in time or sequence – “What seemed to lead up to…?” Putting events in proper sequence helps both the clarifying relationship of events in time “Was it before or after…?” nurse and client to see them in perspective. The “When did this happen?” client may gain insight into cause-and-effect behavior and consequences, or the client may be able to see that perhaps some things are not related. The nurse may gain information about recurrent patterns or themes in the client’s behavior or relationships Presenting reality – offering for “I see no one else in the room.” When it is obvious that the client is misinterpreting consideration that which is real “That sound was a car reality, the nurse can indicate what is real. The backfiring.” nurse does this by calmly and quietly expressing the “Your mother is not here; I am a nurse’s perceptions or the facts not by way of nurse.” arguing with the client or belittling his experience. The intent is to indicate an alternative line of thought for the client to consider, not to “convince” the client that he is wrong. Reflecting – directing client actions, Client: “Do you think I should tell Reflection encourages the client to recognize and thoughts, and feelings back to client; the doctor?” accept his feelings. The nurse indicates that the may use same words Nurse: “Do you think you client’s point of view has value, and that the client should?” has the right to have opinions, make decisions, and think independently. Client: “My brother spends all my money and then has the nerve to ask for more.” Nurse: “This causes you to feel angry?” Restating – repeating the main idea Client: “I can’t sleep. I stay The nurse repeats what the client has said in expressed in different words awake all night.” approximately or nearly the same words the client Nurse: “You have difficulty has used. This restatement lets the client know that sleeping.” he or she communicated the idea effectively. This encourages the client to continue. Or if the client Client: “I’m really mad, I’m really has been misunderstood, he can clarify his upset.” thoughts. Nurse: “You’re really mad and upset.”
3. Seeking information – seeking to make “I’m not sure that I follow.” The nurse should seek clarification throughout clear that which is not meaningful or “Have I heard you correctly?” interactions with clients. Doing so can help the that which is vague nurse to avoid making assumptions that understanding has occurred when it has not. It helps the client to articulate thoughts, feelings and ideas more clearly. Suggesting collaboration – offering to “Perhaps you and I can discuss The nurse seeks to offer a relationship in which the share, to strive, to work with the client and discover the triggers for your client can identify problems in living with others, for his benefit anxiety.” grow emotionally, and improve the ability to form “Let’s go to your room, and I’ll satisfactory relationships. The nurse offers to do help you find what you’re looking things with, rather than for, the client. for.” Recommend or suggest options but Recommendations must be in Example: if the client is exhausted from taking care not advise line with the problem of the client of a loved one, recommend friends to help. Inappropriate: recommend to client to seek counseling – not helpful in relieving exhaustion Inappropriate: decision on longterm facility admission requires family members Summarizing – organizing and “Have I got this straight?” Summarization seeks to bring out the important points summing up that which has gone “You’ve said that…” of the discussions and to increase the awareness before “During the past hour, you and I and understanding of both participants. It omits the have discussed…” irrelevant and organizes the pertinent aspects of the interaction. It allows both client and nurse to depart with the same ideas and provides a sense of closure at the completion of each discussion. Translating into feelings – seeking to Client: “I’m dead.” Nurse: “Are Often what the client says, when taken literally, verbalize client’s feelings that he you suggesting that you feel seems meaningless or far removed from reality. To expresses only indirectly lifeless?” understand, the nurse must concentrate on what the Client: “I’m way out in the client might be feeling to express himself this way. ocean.” Nurse: “You seem to feel lonely or deserted.” Verbalizing the implied – voicing what Client: “I can’t talk to you or Putting into words what the client has implied or said the client has hinted at or suggested anyone. It’s a waste of time.” indirectly tends to make the discussion less Nurse: “Do you feel that no one obscure. The nurse should be as direct as understands?” possible without being unfeeling blunt or obtuse. The client may have difficulty communicating directly. The nurse should take care to express only what is fairly obvious; otherwise the nurse may be jumping to conclusions or interpreting the client’s communication. Voicing doubt – expressing uncertainty “Isn’t that unusual?” Another means of responding to distortions of reality about the reality of the client’s “Really?” is to express doubt. Such expression permits the perceptions “That’s hard to believe.” client to become aware that others do not necessarily perceive events in the same way or draw the same conclusions. This does not mean the client will alter his point of view, but at least the nurse will encourage the client to reconsider or reevaluate what has happened. The nurse neither agreed nor disagreed; however, he has not let the misperceptions and distortions pass without comment. Validation – searching for mutual “Tell me whether my For verbal communication to be meaningful, it is understanding, for accord in the understanding of it agrees with essential that the words being used have the same meaning of words yours.” meaning for both (all) participants. Sometimes “Are you using this word to words, phrases or slang terms have different convey that…?” meanings and can be easily misunderstood.

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