...Therapeutic Communication Techniques | Examples | 1. Using silence | The client says: "We drink and smoke a lot here." The student thinks…how can that be…drinking alcohol in a state hospital? But says nothing…using silence…the client then says: "yes we drink a lot of cokes and smoke a lot." | 2. Accepting | "Yes" or "I follow what you said" | 3. Giving Recognition | "I notice you combed your hair." | 4. Offering self | "I'll sit with you awhile." | 5. Using Broad Openings | "What would you like to talk about?" "Tell me what's bothering you." | 6. Using General Leads (using neutral expressions to encourage continued talking by the client) | "Go on. " Ummm..I am listening" "Tell me about it" | 7. Placing he event in time or sequence | "Was this before or after…?" "What seemed to lead up to…?" | 8. Making Observations | "You appear tense" "I notice you are biting your lips." | 9. Encouraging Description of Perceptions | "What do you think is happening to you right now…?" | 10. Restating | Client: "I can't sleep. I stay awake all night." Nurse: "You have difficulty sleeping" | 11. Reflecting | Patient: "Do you think I should tell the doctor?" Nurse: "Do you think you should tell the doctor?" | 12. Focusing | "This point seems worth looking at more closely." "You said something earlier that I want you to go back to." | 13. Exploring | "Would you describe that more fully." | 14. Giving Information | "My name is…I am a student nurse.." | 15. Seeking...
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...TITLE PAGE Therapeutic Communication And Nursing Considerations As a nurse, one must expect to be faced with diverse situations. From teaching patients of varied educational backgrounds to explaining a difficult diagnosis, it is the place of the nurse to build a proper relationship and provide therapeutic communication to each person in the most effective manner possible. This paper first describes the fundamental elements of the communication process, and second, reviews the three levels of communication with nursing applications. Third, this paper differentiates between verbal and nonverbal communications, and furthermore describes the nurse’s focus in the nurse-patient relationship. This paper outlines therapeutic and non-therapeutic communication techniques, with regard to cultural diversity and patients with alternative communication needs. The Communication Process “Communication is an interactive process between two or more persons who send and receive messages to one another”(Varcarolis, 2010, p. 175). “Two common elements of every communication exchange are the sender and receiver. The sender initiates the communication. The sender is a person who has a need or desire to convey an idea or concept to others. The receiver is the individual to whom the message is sent. The sender encodes the idea by selecting words, symbols, or gestures with which to compose a message. The message is the outcome of the encoding, which takes the form of verbal...
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...I believe using more of the therapeutic communication techniques is really going to help me get through to patients during clinical. In the past I have used several of the good and bad communication techniques, but was unaware of the effect they were having on the patient. Now, that I am aware I plan to incorporate more good therapeutic communication into my discussions with patients. I can see my self using accepting, offering self, and giving information without even having to think about it. Accepting is the easiest one, because of course we all already do that when caring on a conversation. Offering self seems to be a second nature for me, I love to talk and connect with my patients, so taking the time to sit down with them even if it...
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...Assessment Task 1 Reflection on Video Vignette At the first when the video started, I observed that the interprofessional communication between the paramedic staff and the nurse was really impressive, as they started by introducing themselves and the involved client who was on the site and it went to give all the information that has been received by the paramedic staff to the nurse who was actually going to look after the client subsequently. But suddenly after a little while, being a student of nursing my attention went towards the therapeutic communication done by the nurse in regards to her client in the video which was very remarkable and I thought it is very significant to observe this video as I was going to learn more about the therapeutic communication which is my chosen path for the future as I planned to be a healthcare professional. Initially, the nurse introduced herself and her roles to the client by lowering her body at client’s eye level which I thought was really well, then again acknowledging that her client could not verbally talk at that time, the nurse asked her client to nod her head for yes response and for the negative response the nurse asked her client to move her head side to side which I thought was fantastic as her client felt comfortable on this and the client nodded her head to nurse. Added to that, the nurse also gave all the information what she was going to do next and also she told her client that she was going to call the...
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...Reflection on Video Vignette What can I take away from the experience of observing this video that will help me develop clinical skill (knowledge and self-awareness) in either therapeutic communication or inter-professional communication? Video Nine - Occupational Therapy Therapeutic communication is used continuously throughout the discussion between Elizabeth (occupational therapist) and Sally (client) who is in recovery from a pregnant stroke. It’s a relationship to provide goal-oriented support to the patient in advancing their physical and emotional wellbeing. Listening to the patient means taking onboard both the content and the feelings the client is expressing, while subsiding personal judgement and ideas to centre attention on patient needs and goals. Elizabeth executes effective therapeutic communication which I can confidently mimic, to help me develop skills in clinical. What? Sally has been hospitalised for 5 days and is recovering from a pregnant stroke. Elizabeth uses a therapeutic approach to engage and talk to Sally about her needs for returning home and living safely. Elizabeth introduces herself to deliberately ensure Sally knew her name and how she was helping her. This is effective in clinical as patients may have various doctors and can become disoriented with the different people. Introductions ensures the client knows who each person is, and how they are helping them. When talking to clients, showing your body language is engaged with the client’s...
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...Communication and Therapeutic Relationships in Nursing/Midwifery A therapeutic relationship can be described as one that offers support and care without being judgemental and can provide trust and a feeling of safety from threatening situations(Mc Klindon et al1999). In contrast to a social relationship it differs greatly in that a therapeutic relationship consists of collaborated goals which are identified when the relationship is initiated and once these goals are fulfilled the relationship is terminated in a therapeutic way(Nurses Association of New Brunswick2000).There are many communication techniques that can prove to be useful in certain situations for example verbal and nonverbal communication as well as being aware of body language and tone of voice which can benefit the therapeutic relationship. It is essential to learn how to be assertive as it can promote fairness and efficiency at work(Hodgetts 2011). One must learn how to communicate effectively with clients from different cultures who speak different languages in order to ascertain the clients needs and in order to build the therapeutic relationship. Developing a Therapeutic Relationship In order to develop a therapeutic relationship it has been found that a number of skills are required for example conveying empathy and understanding, accepting individuality, providing support, promoting equality, demonstrating respect, maintaining boundaries, self awareness and being there for the client in a genuine manner(Dziopa...
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...In the 21st century, nursing requires an immense amount of knowledge and commitment to an evolving patient population beyond the standard administrative practices outlined in the traditional nursing handbook. This knowledge and commitment to the patient is provided by use of therapeutic communication within the nurse-patient relationship. When therapeutic communication is not proficient, patient safety and positive health outcomes are compromised. In the film, One Flew Over the Cuckoo’s Nest (1975), the lack of therapeutic communication used by the nurses in the psychiatric unit had a negative impact on patient safety and positive health outcomes. These patients were verbally abused, treated with no dignity and had very few rights. The nurses were judgmental of the cognitive impairments and coping difficulties the patients endured...
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...use this understanding as a guide to our communication with others” (Robbins, 1986). In other words, we, as nurses, should take in account that we all have different values, thoughts and practices, however, any discrepancies in what a patient believes in should not reflect on the way we communicate. Reflecting back on my interaction with my client, I illustrated many aspects of therapeutic communication along with non-therapeutic communication. Therapeutic communication focuses mainly on the patient. It is used to effectively communicate with a patient and alleviate any anxiety or fear the patient may be experiencing, which may also reduce the complexity of their treatment. On the contrary, non-therapeutic communication refers to the opposite. The use of non-therapeutic communication might violate a client’s privacy by asking personal questions or may even worsen a client’s anxiety...
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...Therapeutic Communication Overview: While sitting in the milieu, I had a conversation with patient “M”, a schizophrenic with severe depression. She is sitting silently across the table from me, listening to another patient talk. Her face looks emotionless, almost distant. She is dressed well, with a full face of make up, and her is done up. D: Hi, “M”, what’s on the agenda for you today? E: Since she was not talking to anyone, I thought this would be a neutral enough opening statement to start a conversation. A: “Oh, not much, getting ready to go home tomorrow. I have to clean out my fridge when I get there; it’s full of rotting food”. B: She’s thinking about what she left behind when she left her home to come to Bayridge. It sounds like her admission here was not necessarily planned nor did she have time to prepare her home for her departure. C: I’m excited for her to be going home, especially since I know this patient’s history from reading her chart, she’s been in for over three weeks. She left her life rather suddenly because of her severe instability, so it is good to know that she and her doctors feel like she is stable enough to go home. D: “That’s exciting you get to go home! Do you feel ready?” E: I’m acknowledging her news with my own feelings for her, and asking her if she feels ready, considering it is a big step in her recovery. It was a close ended question. A: “I am ready. I’m ready to get out of here. I just hope I don’t have to come back. This is...
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...Analysis of Jane’s Condition Jane Vuong, a 24 year old Vietnamese undergraduate student was admitted into the hospital Emergency Department presenting with anxiety, difficulty speaking, breathing and dusky lips following severe chest tightness during an exercise session at the local martial arts school. On examination she had a wheezing sound when breathing. She has no history of asthma but says she has some allergies which she treats with herbs. Her colleague who brought her to the emergency room also claims that Jane has recently had difficulty breathing while taking the stairs up to the martial arts studio and she no longer rides her bicycle to the studio. Jane is in her second year at the local University where she is studying cellular biology. Jane is a bright student who studies a lot and also works part time in the Universities’ research center which gives her extra cash. She admits that she has been having a dry cough for some months which she associated with allergies. She also relates her inability to ride her bike to her allergies. Jane smokes at least one packet of cigarettes on a daily basis, and during assessment appears to be in the pre-contemplation stage. Jane had six months earlier tested positive for hepatitis B. This surprised her a lot because she was asymptomatic. Though she denies drug use, she admits to having multiple sexual partners. She does not want to be in a long-term relationship because she claims it could complicate her life. She also admits...
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...THERAPEUTIC COMMUNICATION TECHNIQUES 1. USING SILENCE...utilizing absence of verbal communication. Silence in itself often encourages the patient to verbalize if it is an interested, expectant silence. This kind of silence indicated to the patient that the nurse expects him to speak, to take the initiative, to communicate that which is most pressing. It gives the patient the opportunity to collect and organize his thoughts, to think through a point, or to consider introducing a topic of greater concern to him than the one being discussed. A positive and accepting silence can be a valuable therapeutic tool. (1) It encourages the patient to talk; (2) directs his thoughts to the task at hand--the consideration of his problem; (3) reduces the pace of the interview when either the nurse or the patient is pressing or pushing too hard; (4) gives the patient time to consider alternative courses of action, delve deeply into his feelings, or weigh a decision; (5) and allows the patient to discover that he can be accepted even though he is silent, that even though he is shy and quiet, he has worth and is respected by another person. Much nonverbal communication occurs during these interludes. The nurse needs to be alert to what she is communicating as well as perceiving. Even momentary loss of interest can be interpreted as indifference. Schwartz and Schockley state that the utilization of silence is often difficult for nursing personnel, since they...
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...Reflective essay HLSC110 Question: What can I take away from the experience of observing this video that will help me develop clinical skill (knowledge and self-awareness) in either therapeutic communication or inter-professional communication? Therapeutic communication is the communication between the nurse and the patient, focusing on the patient’s wellbeing (Berman et al, 2015). In the video of the radiographer working in the emergency department, therapeutic communication is demonstrated between the radiographer and his patient. After reflecting over the therapeutic communication that’s shown in this video, it has helped me developed different techniques that are used with this communication and how to approach these techniques in the best way. Using Discolls reflection cycle, the ‘what’ comes first, describing what has happened in the situation. The therapeutic communication in this video starts with the Radiographer Peter, abruptly entering the room of pregnant patient Sally, who has seemed to have had a stroke. Not realizing that Sally can’t talk, Peter immediately starts to ask her questions before Sally’s husband has to step in and explain what her situation is. Peter then carry’s on asking Sally’s husband questions about herself and explains that he needs to do a CT scan of her brain. Peter then makes it clear that because a CT scan requires them to use radiation that there is harm to the baby. Sally’s husband becomes concerned and tries to sort out with Peter...
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...Upon reflection of the first vignette I am able to gain a clear understanding of effective communication therapy techniques. What stands out to me the most from the first video is the trust that both sally and her husband have in the paramedics. There is a sense of complete faith and willing participation from both Sally and her husband. How the paramedics achieve this involvement is by implementing a holistic approach and some great communicative skills such as expressing empathy, active listening, encouragement and providing information. 'The focus needs to be person-centred rather than nurse- or task-focused and the relationship is a key element’(Bach and Grant, 2011). By taking time to do this, health care workers can advance their therapeutic relationships with patients, encouraging compassionate care. From this we can therefore see that it is different from social and collegial communication. In this essay I will discuss the communication techniques used and demonstrated in the first vignette, how they are applied and explain why they are successful. Empathy in one of many ways can be described as the ability to supportively communicate a sensitive awareness and affirmation of another person's feelings and the unique meanings attached to them (Mearns and Thorne, 2007). Healthcare workers who are committed and compassionate also must use empathy as a tool to build a rapport with their patient. This is demonstrated in the first vignette through the...
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...J Clin Epidemiol Vol. 50, No. 12, pp. 1311–1318, 1997 Copyright © 1997 Elsevier Science Inc. 0895-4356/97/$17.00 PII S0895-4356(97)00203-5 The Powerful Placebo Effect: Fact or Fiction? Gunver S. Kienle* and Helmut Kiene ¨ Institut fur Angewandte Erkenntnistheorie und Medizinische Methodologie, D-79112 Freiburg, Germany ABSTRACT. In 1955, Henry K. Beecher published the classic work entitled ‘‘The Powerful Placebo.’’ Since that time, 40 years ago, the placebo effect has been considered a scientific fact. Beecher was the first scientist to quantify the placebo effect. He claimed that in 15 trials with different diseases, 35% of 1082 patients were satisfactorily relieved by a placebo alone. This publication is still the most frequently cited placebo reference. Recently Beecher’s article was reanalyzed with surprising results: In contrast to his claim, no evidence was found of any placebo effect in any of the studies cited by him. There were many other factors that could account for the reported improvements in patients in these trials, but most likely there was no placebo effect whatsoever. False impressions of placebo effects can be produced in various ways. Spontaneous improvement, fluctuation of symptoms, regression to the mean, additional treatment, conditional switching of placebo treatment, scaling bias, irrelevant response variables, answers of politeness, experimental subordination, conditioned answers, neurotic or psychotic misjudgment, psychosomatic phenomena...
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...Chapter 1 1.1 Introduction By synthesizing the data from various studies and research, this dissertation will aim to systematically review the current literature of evidence for therapeutic hypothermia (TH) post cardiac arrest. The research question is as follows: does therapeutic hypothermia treatment present positive neurological outcomes for post cardiac arrest victims? 1.1a Rationale: Whilst working in the Intensive Care Unit, I had the opportunity to witnessed a patient being cooled (therapeutic hypothermia concept) after experiencing out of hospital post cardiac arrest. I was intrigued to learn more about the concept as I had never heard or seen it done before. This prompted me to research further on the evidence based practice pertinent to TH treatment on post cardiac arrest victims. Patients who have suffered post cardiac arrest are usually cared for in a critical care environment such as the intensive care unit (ICU), and the survival rate for in hospital incidents is considered to be poor (Gwinnut et al 2000). Furthermore, according to Becker (1993) and Rea (2004), approximately 0.04% to 0.19% of out of hospital cardiac arrest incidence occur each year in industrial countries. Around 14% to 40% of these victims regain Return of Spontaneous circulation (Giraud 1996, Finn 2001, Fischer 1997), and only 7% to 30% were able to attain good neurological outcomes on discharge (Jennings 2001, Westfal 1996, Weston 1997). By critically reviewing the literature of evidence...
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