therapeutic communication

· Using therapeutic Communications

Focuses on the specific needs of the patient in where the exchange of information occurs Is always client centered Client's perception of the problem Facilitates expression of emotions and expression of feelings Teaches self care Recognizes the needs of the patient Implement interventions to address needs Come to some sort of resolution

1 cup = ___ oz

8 oz

Sublimation (defense mechanism)

: Substituting a socially acceptable activity for an impulse that is unacceptable Person who has quit smoking sucks on hard candy when the urge to smoke arises Person goes for a 15-minute walk when tempted to eat junk food

channels of communication

: auditory, visual, and kinesthetic (hearing, sight, and movement/body language)

Consensual validation (Therapeutic)

: searching for mutual understanding for accord in the meaning of words. "Tell me whether my understanding of it agrees with yours.' "Are you using this word to convey that...?"

Verbalizing the implied (Therapeutic)

: voicing what the client has hinted at or suggested Client: "I can't talk to you or anyone. It's a waste of time." Nurse: "Do you feel that no one understands?"

Reflective

" I dislike how this med tastes" Nurse-"You've been having trouble with taste?".

Clarifying

" I don't feel very well today" Nurse- "Can you be more specific as to what is bothering you"

Sequencing

"I am tired after Metoprolol" Nurse- " So you become tired right after?"

Directing

"I have been injecting insulin into my abdomen". Nurse- " Where specifically?". " By my belly button". Nurse- " You want to inject closer to where your abdomen lies just about your waist to either the left or right". "Please demonstrate for me".

Assertive

"I have noticed on two occasions this week you have been late". "I am going to be honest this delays me from leaving on time to pick up my daughter". " So, if you can be a little more prompt, I would appreciate your consideration"

Social zone

4 to 12 feet; common for business events or meetings

Intimate zone

0 to 18 inches

1 L = ? quarts

1 quart

1 L = ___ mL

1000

1 kg

1000 g

1 mg = ___ mcg

1000 mcg

1g = ___ mg

1000 mg

Public zone

12-25 feet For speeches, teachers in classrooms, and passersby

1 T = ___ mL

15

Personal zone

18 to 36 inches AKA personal space or personal bubble People tend to protect their personal space and do not like it invaded by another person

3t = __ T

1T

1 oz

2 T

1 kg ___ lb

2.2

1 oz = ___ mL

30 mL

1 t = ___ mL

5 mL

Introjection (defense mechanism)

Accepting another person's attitudes, beliefs, and values as one's own Person who dislikes guns becomes an avid hunter, just like a best friend

Reaction formation (defense mechanism)

Acting the opposite of what one thinks or feels Woman who never wanted to have children becomes a supermom Person who despises the boss tells everyone what a great boss she is

Non-therapeutic Techniques

Advising, agreeing, belittling, challenging, defending, disagreeing, disapproving, giving approval, giving literal resonses, indicating the existence of an external source, interpreting, introducing an unrelated topic, making sterotyped comments, probing, reassuring, rejecting, requesting an explanation, testing, using denial

· Blocks to communication

Aggression which is different than assertive Failure to actively listen (interrupting) Failure to address the patient how they want to be addressed such as Mr. and Mrs. (or honey) Clichés which come off as not personalizing your care or discounting the patient Yes/No comes off as terse Why/How comes off as questioning or condescending Probing comes off as not believing what they are telling you Leading comes off as pointing them in the direction you want Giving advice can come off as you want them to do what you think is best in your mind Being judgmental is not putting yourself in their shoes Changing the subject, false assurance, Gossip/rumor all come off as disrespectful

resolving conflict

Avoiding-stay away Collaboration-work together Competing-might have same interests but competing to have an edge over the other person Compromise-each person wins Cooperation/Accommodation-decide to work together and maybe accommodate each other in some way, shape, or form Smoothing-allows you to move forward

Active Listening and Observation

Concentrates completely on what the patient is saying without interruption Observing non-verbal or body language These can assist with: The most important issue currently It allows for further questions and additional techniques Can understand the perspective of the patient Allows for interpretation without assumptions or bias

Suppression (defense mechanism)

Conscious exclusion of unacceptable thoughts and feelings from conscious awareness Student decides not to think about a parent's illness to study for a test Woman tells a friend she cannot think about her son's death right now

professional therapeutic communication

Conversation-be able to speak to what you are doing in a professional manner and respect their viewpoint Actively listen-this means really listening to what they have to say without interruption Silence-see this as reflection and tying into actively listening Touch-be careful as this can be misconstrued; you need to develop a comfort level and rapport, and use your judgement Humor-use your judgment as this can be misinterpreted as not taking what they are saying seriously; laughter can be therapeutic for both sides if there is a comfort level

Dissociation (defense mechanism)

Dealing with emotional conflict by a temporary alteration in consciousness or identity Amnesia that prevents recall of yesterday's auto accident Adult remembers nothing of childhood sexual abuse

Repression (defense mechanism)

Excluding emotionally painful or anxiety-provoking thoughts and feelings from conscious awareness Woman has no memory of the mugging she suffered yesterday Woman has no memory before age 7, when she was removed from abusive parents

Rationalization (defense mechanism)

Excusing own behavior to avoid guilt, responsibility, conflict, anxiety, or loss of self-respect -Student blames failure on teacher being mean -Man says he beats his wife because she does not listen to him

Undoing (defense mechanism)

Exhibiting acceptable behavior to make up for or negate unacceptable behavior Person who cheats on a spouse brings the spouse a bouquet of roses Man who is ruthless in business donates large amounts of money to charity

Conversion (defense mechanism)

Expression of an emotional conflict through the development of a physical symptom, usually sensorimotor in nature Teenager forbidden to see X-rated movies is tempted to do so by friends and develops blindness, and the teenager is unconcerned about the loss of sight

Denial (defense mechanism)

Failure to acknowledge an unbearable condition; failure to admit the reality of a situation or how one enables the problem to continue Diabetic person eating chocolate candy Spending money freely when broke Waiting 3 days to seek help for severe abdominal pain

Touch functional-professional social friendship love sexual

Functional-professional- example would be checking pulses or auscultating lungs Social-polite- example would be a pat on the back, fist bump, or handshake Friendship-warmth- example would be a hug Love-intimacy- example would be a married couple Sexual-arousal- example would be intercourse between two people

if receiver agrees vs disagrees

If receiver agrees: congruent If not, incongruent

Fixation (defense mechanism)

Immobilization of a portion of the personality resulting from unsuccessful completion of tasks in a developmental stage Never learning to delay gratification Lack of a clear sense of identity as an adult

· Assertive skills

Is the ability to express feelings, emotions, and ideas in an open and honest way. It can assist with resolving conflict, solving problems, or expressing feelings. It is especially helpful for those who do not normally display emotions, deal with those in authority very well, or are in a challenging situation. Always stick to the facts and remain calm. Even though you might be feeling emotional at the time. Call them out in respectful way

Identification (defense mechanism)

Modeling actions and opinions of influential others while searching for identity, or aspiring to reach a personal, social, or occupational goal Nursing student becoming a critical care nurse because this is the specialty of an instructor she admires

Regression (defense mechanism)

Moving back to a previous developmental stage to feel safe or have needs met A 5-year-old asks for a bottle when new baby brother is being fed Man pouts like a 4-year-old if he is not the center of his girlfriend's attention

Passive-aggressive

Oh look, she has finally blessed us with her presence". "Can we continue now that she is finally here?".

Interviewing Techniques

Open-ended questions or comments Closed questions or comments Validating questions or comments Clarifying questions or comments Reflective questions or comments Sequencing questions or comments Directing questions or comments

Compensation (defense mechanism)

Overachievement in one area to offset real or perceived deficiencies in another area Napoleon complex: diminutive man becoming emperor Nurse with low self-esteem working double shifts so that her supervisor will like her

Resistance (defense mechanism)

Overt or covert antagonism toward remembering or processing anxiety-producing information Nurse is too busy with tasks to spend time talking to a dying patient. Person attends court-ordered treatment for alcoholism but refuses to participate

PEARLA

Presence-being there Empathy-feel for the other person Acknowledge-acknowledge their position Reflect/Reframe-think about it and put it in another perspective Listen openly-which means an open mind Ask questions-asks for clarification or this can be used to move forward or compromise

Substitution (defense mechanism)

Replacing the desired gratification with one that is more readily available Woman who would like to have her own children opens a day care center

Intellectualization (defense mechanism)

Separation of the emotions of a painful event or situation from the facts involved; acknowledging the facts but not the emotions Person shows no emotional expression when discussing serious car accident

SBAR

Situation- "I am calling about Mr. Jones and he is having chest pain at rest". Background-Mr. Jones has a history of CAD, CHF, and T2DM and is in the hospital for unstable angina. He is in CCU Room 2. Assessment-He is diaphoretic, jaw hurts, anxious, arm hurts, and has impending doom; 10/10 CP @ rest, no response to 0.3 mg SL nitro times 3 doses; VS 140/95, 130, 26, SpO2 92% on RA, and T-37.3 Recommendation: STAT 12 lead EKG, STAT troponin/CK-MB, CBC, and BMP, Prepare for cardiac cath lab, Give 325 mg PO ASA chewed, 150 mg Plavix (Clopidogrel), 5 mg metoprolol IVP over 2 minutes, and initiate a heparin drip per protocol. Place O2 to maintain SpO2 >=95% VS Q 15 and assess CP Q 15.

Validating

So in the AM, you take your water pill?"

communication

The exchange of info between two people which generates meaning for both Encoder sends, decoder receives has content and context:

Projection (defense mechanism)

Unconscious blaming of unacceptable inclinations or thoughts on an external object Man who has thought about same-gender sexual relationship but never had one beats a man who is gay -Person with many prejudices loudly identifies others as bigots

Cultural Competence:

Understand where other individuals come from ,their background, religious/cultural preferences-diet, prayer, language, and body language are some examples Always use an interpreter if the patient is non-English speaking as this is mandated by law Actively listen, be attentive, be respectful, modify your approach, consider comfort with male/female, and avoid judgement

Displacement (defense mechanism)

Ventilation of intense feelings toward persons less threatening than the one who aroused those feelings Person who is mad at the boss yells at his or her spouse Child who is harassed by a bully at school mistreats a younger sibling

communication Forms

Verbal-spoken, non-verbal body language, touch, eye contact, facial expressions, posture, gait, gestures, physical appearance, dress and grooming, sounds, and silence.

Silence: (Therapeutic)

absence of verbal communication, which provides time for the client to put thoughts or feelings into words, to regain composure, or to continue talking Nurse says nothing but continues to maintain eye contact and conveys interest.

Giving recognition (Therapeutic)

acknowledging, indicating awareness "Good morning, Mr. S ..." "You've finished your list of things to do." "I notice that you've combed your hair."

Broad opening: (Therapeutic)

allowing client to take the initiative in introducing the topic. "is there something you'd like to talk about?" Where would you like to begin?"

Open ended

answers can be a wide range

Testing (non-therapeutic)

appraising the client's degree of insight "Do you know what kind of hospital this is?" "Do you still have the idea that...?"

Encouraging comparison (Therapeutic)

asking that similarities and differences be noted. Tell me when you feel anxious "Was it something like....?" "Have you had similar experiences?"

Encourage expression (Therapeutic)

asking the client to appraise the quality of his or her experiences What are your feelings in regard to...?" "Does this contribute to your distress?"

Formulating a plan of action (Therapeutic)

asking the client to consider kinds of behavior likely to be appropriate in future situations "What could you do to let your anger out harmlessly?" "Next time this comes up, what might you do to handle it?"

Requesting an explanation (non-therapeutic)

asking the client to provide reasons for thoughts, feelings, behaviors, and events "Why do you think that?" "Why do you feel that way?"

Encouraging description of perceptions (Therapeutic)

asking the client to verbalize what he or she perceives "what is happening?" "What does the voice seem to be saying?"

Interpreting (non-therapeutic)

asking to make conscious that which is unconscious; telling the client the meaning of his or her experience "What you really mean is ..." "Unconsciously you're saying ..."

Defending (non-therapeutic)

attempting to protect someone or something from verbal attack "This hospital has a fine reputation." "I'm sure your doctor has your best interests in mind."

Indicating the existence of an external source (non-therapeutic)

attributing the source of thoughts, feelings, and behaviors to others or to outside influences "What makes you say that?" "What made you do that?" "Who told you that you were a prophet?"

Introducing an unrelated topic (non-therapeutic)

changing the subject Client: "I'd like to die." Nurse: "Did you have visitors last evening?"

Placing event in time or sequence (Therapeutic)

clarifying the relationship of events in time "What seemed to lead up to...?" "Was this before or after...?" "When did this happen?"

intrapersonal communication

communication with oneself self talk

Focusing (Therapeutic)

concentrating on a single point "This point seems worth looking at more closely." "Of all the concerns you've mentioned, which is most troublesome?"

Exploring (Therapeutic)

delving further into a subject or an idea "Tell me more about that." "Would you describe it more fully?" "What kind of work?"

Challenging (non-therapeutic)

demanding proof from the client "But how can you be president of the United States?" "If you're dead, why is your heart beating?"

disapproving (non-therapeutic)

denouncing the client's behavior or ideas "That's bad." "I'd rather you wouldn't ..."

interpersonal communication

direct, face-to-face communication between two or more people

Reflecting (Therapeutic)

directing client actions, thoughts, and feelings back to client Client: "Do you think I should tell the doctor...?" Nurse: "Do you think you should?" Client: "My brother spends all my money and then has nerve to ask for more." Nurse: "This causes you to feel angry?"

Voicing Doubt (Therapeutic)

expressing uncertainty about the reality of the client's perceptions "Isn't that unusual?" "Really?" "That's hard to believe."

Belittling (non-therapeutic)

feelings expressed—misjudging the degree of the client's discomfort Client: "I have nothing to live for ... I wish I was dead." Nurse: "Everybody gets down in the dumps," or "I've felt that way myself."

General leads (Therapeutic)

giving encouragement to continue "Go on." "And then?" "Tell me about it."

Incivility/Bullying:

horizontal or lateral violence can be overt or covert which means out in the open or behind the scenes.

proxemics

how close you are to someone else

Agreeing (non-therapeutic)

indicating accord with the client "That's right." "I agree."

Accepting (Therapeutic)

indicating reception "Yes." "I follow what you said." Nodding

Reassuring (non-therapeutic)

indicating there is no reason for anxiety or other feelings of discomfort "I wouldn't worry about that." "Everything will be alright." "You're coming along just fine.

communication levels

intrapersonal, interpersonal, group, mass (organizational)

Giving information (Therapeutic)

making available the facts that the client needs "My name is ..." "Visiting hours are ..." "My purpose in being here is ..."

Offering Self: (Therapeutic)

making oneself available "I'll sit with you awhile." "I'll stay here with you." "I'm interested in what you think."

Presenting Reality (Therapeutic)

offering for consideration that which is real "I see no one else in the room." "That sound was a car backfiring." "Your mother is not here; I am a nurse."

Making stereotyped comments (non-therapeutic)

offering meaningless clichés or trite comments "It's for your own good." "Keep your chin up." "Just have a positive attitude and you'll be better in no time."

Suggesting collaboration (Therapeutic)

offering to share, to strive, and to work with the client for his or her benefit "Perhaps you and I can discuss and discover the triggers for your anxiety." "Let's go to your room, and I'll help you find what you're looking for."

Disagreeing (non-therapeutic)

opposing the client's ideas "That's wrong." "I definitely disagree with ..." "I don't believe that."

Summarizing (Therapeutic)

organizing and summing up that which has gone before "Have I got this straight?" "You've said that...." "During the past hour, you and I have discussed...."

Probing (non-therapeutic)

persistent questioning of the client "Now tell me about this problem. You know I have to find out." "Tell me your psychiatric history."

Using Denial (non-therapeutic)

refusing to admit that a problem exists Client: "I'm nothing." Nurse: "Of course you're something—everybody's something." Client: "I'm dead." Nurse: "Don't be silly."

Rejecting (non-therapeutic)

refusing to consider or showing contempt for the client's ideas or behaviors "Let's not discuss ..." "I don't want to hear about ..."

Restating (Therapeutic)

repeating the main idea expressed Client: "I can't sleep. I stay awake all night." Nurse: "You have difficulty sleeping." Client: "I'm really mad, I'm really upset." Nurse: "You're really mad and upset."

Giving literal responses (non-therapeutic)

responding to a figurative comment as though it were a statement of fact Client: "They're looking in my head with a television camera." Nurse: "Try not to watch television" or "What channel?"

Giving approval (non-therapeutic)

sanctioning the client's behavior or ideas "That's good." "I'm glad that ..."

probing

searching or investigating

Seeking information (Therapeutic)

seeking to make clear that which is not meaningful or that which is vague "I'm not sure that I follow." "Have I heard you correctly?"

Translating into feelings (Therapeutic)

seeking to verbalize client's feelings that he or she expresses only indirectly Client: "I'm dead." Nurse: "Are you suggesting that you feel lifeless?" Client: "I'm way out in the ocean." Nurse: "You seem to feel lonely or deserted."

advising (non-therapeutic)

telling the client what to do "I think you should ..." "Why don't you ..."

A feedback loop is how

the decoder lets the encoder know they have received the message

Making observations (Therapeutic)

verbalizing what the nurse perceives "You appear tense." "Are you uncomfortable when...?"

Close ended

yes or no

Passive

you don't say anything even though it might be bothering you; you let it go

Aggressive

you don't say anything for a few days, you become angry and have an outburst towards the other person, and stomp away.

1. Discuss factors influencing the communication process.

§ Developmental level-stage § Sex-male, female, or transgender § Socio-cultural-economic, social, cultural, and external environment § Roles and responsibilities-think of power § Space and territory-think of surroundings § Physical, mental, and emotional states § Values-what you see as important such as having integrity § Environment-both internal and external