The theoretical background of Effective Therapeutic Communication is the main focus of this study. Attitude, environment, socio-cultural and ethnic background, past experiences, knowledge, intersubjectivity, interpersonal relationships and perceptions are all conditions and principles that contribute to achieving, maintaining, and understanding this concept (Shives, 2008). It is worth noting that effective therapeutic communication is a learned process that benefits everyone involved. Self-awareness plays a crucial role in this form of communication.
Both nurses and clients need to be aware of their own emotions and the emotions of others, being mindful of the messages they send and receive. Nurses who lack self-awareness will struggle to build and sustain therapeutic relationships with patients (Shyder, 2002). According to Peplau's influential work, both the nurse and client bring their individual experiences, beliefs, and expectations into interpersonal relationships. These interactions help improve communication and promote optimal health.
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According to Deborrah (2007), effective therapeutic communication requires the nurse to allocate sufficient time for patient communication. Reusch and Bateson (2008) state that Jurgen Reusch's theory of communication emphasizes perception, efficiency, appropriateness, flexibility, and feedback in the communication process. Additionally, Deborrah (2007) explains that various factors such as biological processes, psychosocial influences, developmental milestones, societal and healthcare trends, and technological advances contribute to communication. These factors collectively influence individuals' verbal and nonverbal communication skills including what they say and how they communicate. In face-to-face communication, one or more of the five senses are used as channels of communication (Deborrah 2007).
According to Hall (2002), the more senses are involved in communication, the more effectively information is obtained and sent. Various factors related to nurses can impact their ability to communicate with patients, including their state of health,
home situation, workload, staff relations, and past experience. These factors can affect a nurse's attitude, thinking, concentration, and emotions (White, 2005). Moreover, education also plays a significant role in influencing communication.
According to White (2005), patients' vocabulary and understanding of concepts increase as they acquire more knowledge. The educator needs to adjust the subject to a level that the listener can understand. Effective communication depends on the emotional state of individuals involved in the conversation. Language also plays a role, as speaking the same language aids understanding, although regional accents or dialects can hinder communication (White, 2005). Additionally, individual attention given to communication significantly impacts its outcome. Active listening, a purposeful form of listening, enhances clarity and mutual understanding in conversations (Cantos, 2009). Finally, it is worth noting that exposure to different environments influences communication.
The discussion of personal health concerns in public can cause discomfort and impact emotions and thoughts. Privacy is important for effective communication (White, 2005). Culture plays a crucial role in communication, as interpersonal communication involves both the client's culture and the nurse's culture. Therefore, it is essential for nurses to understand how culture influences verbal and nonverbal communication skills to interact appropriately with diverse clients.
Cultural values that may impact interpersonal interaction include acceptance of equality of status and power, collectivism versus individualism, preference for masculine versus feminine traits, and the level of need to avoid uncertainty (Frisch, 2006). It is crucial for nurses to understand the cultural values of the individuals in their employment region, particularly when those values differ from the dominant culture. For instance, while optimal health is immensely prioritized in the dominant US culture, it may not hold
the same importance for other cultures where little effort is devoted to health due to various factors, such as limited resources or different priorities (White, 2005). Additionally, proxemics, the study of personal space and its impact on communication, plays a significant role in communication effectiveness. Edward T. Hall extensively studied this concept and found that humans, like animals, have their own territories and comfort zones which greatly influence their interactions.
The most effective category of comfort zone for nurse-patient interactions is the Personal Zone. When proper proxemics is observed and comfort space is provided, communication will be effective and fruitful (White, 2005). Roger’s principle of integrality also has implications for the nature of holistic communication. Rogers defines integrality as a “continuous mutual human field and environmental field process”. Rogers describes person and environment as an "open system" and states that "man and environment are continuously exchanging matter and energy with one another".
The implication is that everything about us - our thoughts, behaviors, emotions, conscious and unconscious elements - interacts with and impacts everything and everyone in our surroundings. Similarly, everyone and everything in our surroundings constantly exchange matter and energy with us. Incorporating this idea into our lives challenges us to change and improve ourselves. (Dossey and Keegan, 2009) Noise theory states that an undesired or random signal called noise disrupts message transmission and introduces errors to the sent messages or signals.
For clear and effective communication, it is important to minimize or eliminate noise. According to Chitode (2010), noise refers to any factors that can interfere with communication. In the field of conversation, both internal and external factors can impact the self-esteem and attention of nurses.
Simply being in the presence of certain individuals can create tension. This can be especially true when these individuals are older, more powerful, wealthy, attractive, or highly esteemed. Additionally, some individuals may struggle to perform accurately when they know they are being observed. Research suggests that people who try to control others often trigger defensive reactions.
The interruption of individuals can reverse their self-growth, hindering progressive development and effectiveness. To ensure progress, timely support and guidance from superiors or leaders should be provided, without causing the communicator to feel threatened. Certain messages can also impact an individual's communication abilities, with manipulative messages subverting communication and supportive statements increasing comfort and confidence. In order to be more effective therapeutic communicators, nurses must push their comfort zones and expand their perceptions of what they can and cannot do. This perspective affects interactions with various individuals. Research indicates that effective communication between nurses and physicians improves problem solving, decision making, and treatment outcomes. Nurses need to respond not only to the content of verbal messages from clients but also to the emotions expressed. (Mortenson, 2009; Shives, 2008; Boyle & Kochinda, 2004; Schmidt & Svarstad, 2002)
Understanding how clients view and feel about a situation is important before responding, as mental health providers need to gain trust and gather information from the patient, their family, friends, and relevant social relationships in order to involve them in an effective treatment plan (Antai-Otong and Wasserman, 2003; Epstein, Borrell, and Caterina, 2000). In professions like nursing, clear and open communication between the patient and the nurse, as well as between the nurse and other members of the healthcare team, is a sign of quality
patient care (Cantos, 2009). To ensure understanding, one can assume value, clarify, and confirm, and then enhance this understanding by identifying merits, building on expressed ideas, and balancing merits and concerns. Supporting others can be achieved by expressing appreciation and being specific (Fomey, 2009). Effective therapeutic communication is achieved by using the nursing process and establishing a maintaining a therapeutic relationship.
To effectively communicate, it is important to have a private, quiet, and safe environment. It is also crucial to consider the unique situation before responding and explore alternative options. Accepting people for who they are, including their strengths and weaknesses, is essential. It's worth remembering that there is always room for growth and healthy living (Watchtel, 2011).
One way to achieve good communication is by demonstrating interest through body language like leaning forward, paying attention, nodding in agreement, and taking notes. Additionally, greeting new ideas with interest and giving individuals undivided attention while maintaining eye contact are vital. Smiling and being friendly can further enhance communication (Phelps, 2000).
The value of technology in nursing should be recognized; nurses should view it as an extra tool for their practice rather than questioning its presence or use. Technology can help ease constraints on other patient-care resources. Tools like electronic mail, faxes, teleconferences, and CD-ROMS can effectively facilitate communication within the organization (Marquis and Huston, 2006).
Effective communication relies on a mutual commitment to understanding and acknowledging individual differences in communication styles. As professionals, it is important to prioritize the shared goal of meeting the client's needs rather than dwelling on distinctions. The concept of gender encompasses the sex-based divisions of humanity and the accompanying norms, values, and beliefs associated with
gender roles. When discussing gender roles, people often use phrases such as masculine or feminine to describe certain values, behaviors, and products.
Males are generally identified as being firm and direct in their communication style, whereas females are perceived as more meek, resulting in a contrasting dynamic between the two genders. The dominant role in many cultures is typically filled by males, while females are often seen as passive (Ivy and Backlund, 2006). Age is an interesting variable that people heavily rely on to explain changes observed in various human behaviors (Killbourne, 2007). Listening is a crucial and fundamental component of communication. When describing what makes a nurse an effective communicator, patients consistently highlight the significance of listening.
According to Dougherly and Lister (2004), basic communication skills encompass clarification, reflection, probing, summarizing, and open questioning. It is crucial to acknowledge that individuals are not isolated but have a support system consisting of family, friends, and healthcare professionals. Therapeutic communication takes into consideration this entire network and emphasizes a holistic approach. To comprehend an individual's health and life situation, their unique experiences must be taken into account. Positive experiences and the resolution of past crises aid in the development of communication skills as stated by Rosenberg (2008). Intersubjectivity refers to the ability to empathize with and understand someone else's subjective experience. This involves interpreting overt behaviors such as body language, tone of voice, speech rhythm, facial expressions, and verbal content. Psychoanalysis relies on this capacity to share, know, and feel what a patient is experiencing (Jaenicke, 2008).
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