1420 Nursing - Therapeutic Communication Techniques vs. Non-therapeutic Communication Techniques

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Therapeutic Communication Techniques

Table 6-3 pages 119-121

Gives the client the opportunity to collect & organize thoughts, to think through a point, or to consider introducing a topic of greater concern than the one being discussed.

Using silence

Conveys an attitude of reception & regard.
EXAMPLE:
"Yes, I understand what you said."
Eye contact; nodding.

Accepting

Acknowledging; indicating awareness; better than complimenting, which reflects the nurse's judgement .
EXAMPLE:
"Hello, Mr. J. I notice that you made a ceramic ash tray in OT."
"I see you made your bed."

Giving Recognition

Making oneself available on an unconditional basis, increasing client's feelings of self-worth
EXAMPLE:
"I'll stay with you awhile."
"We can eat our lunch together."
"I'm interested in you."

Offering Self

Allows the client to take the initiative in introducing the topic; emphasizes the importance of the client's role in the interaction.
EXAMPLE:
"What would you like to talk about today?"
"Tell me what you are thinking?"

Giving Broad Openings

Offers the client encouragement to continue.
EXAMPLE:
"Yes, I see."
"Go on."
"And after that?"

Offering General Leads

Clarifies the relationship of events in time so that the nurse & client can view them in perspective.
EXAMPLE:
"What seemed to lead up to...?"
"Was this before or after...?"
"When did this happen?"

Placing the Event in Time or Sequence

Verbalizing what is observed or perceived. This encourages the client to recognize specific behaivors & compare perceptions with the nurse.
EXAMPLE:
"You seem tense."
"I notice you are pacing a lot."
"You seem uncomfortable when you..."

Making Observations

Asking the client to verbalize what is being perceived; often used with clients experiencing hallucinations.
EXAMPLE:
"Tell me what is happening now."
"Are you hearing the voices again?"
"What do the voices seem to be saying?"

Encouraging Description of Perceptions

Asking the client to compare similarities & differences in ideas, experiences, or interpersonal relationships. EXAMPLE:
"Was this something like...?"
"How does this compare with the time when...?"
"What was your response the last time this situation occurred?"

Encouraging Comparission

Repeating the main idea of what the client has said.
EXAMPLE:
Client: "I can't study. My mind keeps wandering."
Nurse: "You have trouble concentrating."

Restating

Questions & feelings are referred bakc to the client so that they may be recognized & accepted, & so that the client may recognize that his/her point of view was valued - good technique to use when client asks for advice.
EXAMPLE:
Client: "What do you think I should do about my wife's drinking problem?"
Nurse: "What do you think you should do?"

Reflecting

Taking notice of a single idea or even a single word; works especially well with a client who is moving rapidly from one thought to another.
EXAMPLE:
"This point seems worth looking at more closely. Perhaps you & I can discuss it together."

Focusing

Delving further into a subject, idea, experience, or relationship; especially helpful with clients who tend to remain on a superficial level of communication.
EXAMPLE:
"Please explain that situation in more detail."
"Tell me more about that particular situation."

Exploring
One of the most important you will use

Striving to explain that which is vague or incomprehensible & searching for mutual understanding; clarifying the meaning of what has been said facilitates & increases understanding for both client & nurse.
EXAMPLE:
"I'm not sure that I understand. Would you please explain."
"Tell me if my understanding agrees with yours."
"Do I understand correctly that you said...?"

Seeking Clarification & Validation

When the client has a misperception of the environment, the nurse defines reality or indicates his/her perception of the situation for the client.
EXAMPLE:
"I understand that the voices seem real to you, but I do not hear any voices."
"There is no one else in the room but me & you."

Presenting Reality

Expressing uncertainty as to the reality of the client's perceptions; often used with clients experiencing delusional thinking.
EXAMPLE:
"I understand that you believe that to b e true, but I find it hard to accept."
"I find that hard to believe."
"That seems rather doubtful to me."

Voicing Doubt

Putting into words what the client has only implied or said indirectly; can also be used with the client who is mute or is otherwise experiencing impaired verbal communication. This clarifies that which is implicit rather than explicit.
EXAMPLE:
Client: "It's a waste of time to be here. I can't talk to you or anyone."
Nurse: "Are you feeling that no one understands?"
Client: (Mute)
Nurse: "It must have been very difficult for you when your husband died in the fire."

Verbalizing the Implied
careful not to put words in patients mouth

When feelings are expressed indirectly, the nurse tries to "desymbolize" what has been said & to find clues to what the underlying true feelings.
EXAMPLE:
Client: "I'm way out in the ocean."
Nurse: "You must be feeling very lonely right now."

Attempting to Translate Words Into Feelings

When a client has a plain in mind for dealing with what is considered to be a stressful situation, it may serve to prevent anger or anxiety from escalating to an unmanageable level.
EXAMPLE:
"What could you do to let your anger out harmlessly?"
"Next time this comes up, what might you do to handle it more appropriately?"

Formulating a Plan of Action
will use everyday

Non Therapeutic Communication Techniques

Table 6-4 pages 121-122

Indicating to the client that there is no cause for anxiety, thereby devaluing the client's feelings.
EXAMPLE:
"I wouldn't worry about that if I were you."
"Everything will be all right."
Better To Say: "We will work on that together."

Giving Reassurance

Refusing to consider or showing contempt for the client's ideas or behavior.
EXAMPLE:
"Let's not discuss..."
"I don't want to hear about..."
Better To Say: "Let's look at that a little closer."

Rejecting

Sanction or denouncing the client's idea or behavior.
EXAMPLE:
"That's good. I'm glad that you..."
"That bad. I'd rather you wouldn't..."
Better To Say: "Let's talk about how your behavior invoked anger in the other client at dinner."

Approving or Disapproving
do not do

Indicating accord with or opposition to the client's ideas or opinions.
EXAMPLE:
"That's right. I agree."
"That's wrong. I disagree."
"I don't believe that."
Better To Say: "Let's discuss what you feel is unfair about the new community rules."

Agreeing or Disagreeing

Telling the client what to do or how to behave implies that the nurse knows what is best & that the client is incapable of any self-direction.
EXAMPLE:
"I think you should..."
"Why don't you..."
Better To Say: "What do you think would be best for you to do?"

Giving Advice
do not do

Persistent questioning of the client; pushing for answers to issues the client does not wish to discuss.
EXAMPLE:
"Tell me how your mother abused you when you were a child."
"Tell me how you feel toward your mother now that she is dead."
Better Technique: The nurse should be aware of the client's response & discontinue the interaction at the first response of discomfort.

Probing
don't use why

Attempting to protect someone or something from verbal attack.
EXAMPLE:
"No one here would lie to you."
"You have a very capable physician. I'm sure he only has your best interest in mind."
Better To Say: "I will try to answer your questions & clarify some issues regarding your treatment."

Defending

Asking the client to provide the reasons for thoughts, feelings, behavior, and events. Asking why the client did something.
EXAMPLE:
"Why did you think that?"
"Why do you feel this way?"
"Why did you do that?"
Better To Say: "Describe what you were feeling just before that happened."

Requesting an Explanation

Attributing the source of thoughts, feelings, and behavior to to others or to outside influences. EXAMPLE:
"What makes you say that?"
"What made you do that?"
"What made you so angry last night?"
Better To Say: "You became angry when your brothers insulted your wife."

Indicating the Existence of an External Source of Power

When the nurse misjudges the degree of the client's discomfort, a lack of empathy & understanding may be conveyed.
EXAMPLE:
Client: "I have nothing to live for. I wish I were dead."
Nurse: "Everybody gets down in the dumps at times. I feel that way myself sometimes."
Better To Say: "You must be very upset. Tell me what you are feeling right now."

Belittling Feelings Expressed

Cliches & trite expressions are meaningless in a nurse-client relationship.
EXAMPLE:
"I'm fine, & how are you?"
"Hang in there. It's for your own good."
"Keep your chin up."
Better To Say: "The therapy must be difficult for you at times. How do you feel about your progress at this point?"

Making Stereotyped Comments

Denying that a problem exists blocks discussion with the client & avoids helping the client identify & explore areas of difficulty.
EXAMPLE:
Client: "I'm nothing."
Nurse: "Of course your something. Everybody is somebody."
Better To Say: "Your feeling like no one cares about you right now."

Using Denial

With this technique, the therapist seeks to make conscious that which is unconscious, to tell the client the meaning of his/her experience.
EXAMPLE:
"What you really mean is..."
"Unconsciously your saying..."
Better Techniques: The nurse must leave interpretation of the client behavior to the psychiatrist.

Interpreting

Changing the subject causes the nurse to take over the direction of the discussion
EXAMPLE:
Client: "I don't have anything to live for."
Nurse: "Did you have visitors this weekend?"
Better Technique: The nurse must remain open & free to hear the client & to take in all that is being conveyed, both verbally & non-verbally.

Introducing an Unrelated Topic

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