Flashcards on Therapeutic Communication

For example, a client who lived through a terrible accident might express happiness that she survived and her cognition and most of her functional abilities are intact. However, she may appear sad when discussing the need for extended rehabilitation and modifications that must be made to her home to accommodate her as she learns to walk again. At all times, the nurse clarifies inconsistencies between verbal messages and nonverbal behaviors to better understand the client's perspective and thought processes before moving forward with other skills or activities.

analyze a situation from the client's perspective. This technique is a four-step process that assists the nurse to support the client's needs while avoiding over-involvement, over-distancing, or burnout.

1. Identification 2. Incorporation 3. Reverberation 4. Detachment

This phase involves the relaxation of conscious control. In this phase, the nurse is able to contemplate the client and the client's experiences.

In this phase, the nurse considers the client's experiences and feelings rather than his or her own experiences.

This phase involves an interplay of the client's internalized feeling with the nurse's own experiences or fantasies. The nurse is fully absorbed in the client's identity but is able to experience him- or herself separately.

In this phase the nurse withdraws from subjective involvement with the client and resumes his or her own identity. The nurse uses the insight that was gained from the reverberation phase, along with reason and objectivity, to offer meaningful and useful responses to the client.

Also called mindful listening, this technique requires use of all of the senses while listening to another person talk. Attentive listening takes concentration and energy and is the foundation on which all other communication techniques are built. When listening, the nurse focuses on both verbal and nonverbal messages, absorbs all of the content without bias, and avoids formulating a response while the client is still talking. Because this technique can be difficult, the nurse needs to be aware of potential blocks to listening. .When responding, the nurse can use common movements such as head nodding or saying "uh huh." At all times, nurses demonstrate sincerity when using attentive listening.

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: when the nurse is busy planning what is to be said next in the conversation

: when the nurse changes the subject or makes light of what the client is expressing because the nurse is uncomfortable, bored, or tired

when the nurse focuses on the nurse's own intelligence, competence, feelings, or accomplishments instead of on the client

: when the nurse makes assumptions about what the client is really trying to convey in the conversation

: when the nurse frames messages in terms of the nurse's own judgment about whether what the client is saying is right or wrong, mature or immature, calm or anxious, sensible or paranoid, or depressed or simply quiet

: when the nurse focuses on the nurse's own experiences, beliefs, or feelings; may occur when what the client communicates triggers memories or concerns from the nurse's own personal experiences

when the nurse tunes out certain topics in the conversation or hears only certain items that the client is saying; may occur due to anxiety on the part of the nurse.

silence, reflecting, and imparting information.

Although silence can be uncomfortable, responding to everything a client says is not necessary.Silence goes beyond active listening and provides a therapeutic purpose and presence with the client. Silence encourages the client to communicate with the nurse and to make his or her own reflections. It also provides time to: Think Make connections Consider alternatives. When using silence, the nurse should maintain a relaxed but attentive posture and use a nonverbal questioning look. If a period of silence becomes uncomfortable, the nurse should break the silence in order to support the client's physical and emotional needs.

This technique is used to acknowledge what the nurse observes or hears from a client by actively repeating the client's statement. This is reflecting content and provides the client with a chance to either validate what was said or correct a misinterpretation. When reflecting feelings, the nurse verbalizes the feelings that the client implies in a statement.

This technique is providing additional information to a client to help with decision making. The challenge is for the nurse to provide information without offering advice. The goal of this technique is to provide the client with sufficient information to support empowerment. The nurse should also remember not to impart personal information that moves beyond the therapeutic relationship. Personal information beyond name, title, and position should be shared judiciously.

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At times, clients will ask nurses personal questions about marital status, education, number or children, or even health problems. These questions need to be deflected because communication should be focused on the client's health needs and goals. Nurses can use a variety of methods to respond to personal questions from clients such as *Honesty, which allows the nurse to acknowledge her discomfort with personal questions *Benign curiosity, through which the nurse gently asks the client why he or she is asking the question *Refocusing, in which the nurse redirects the client's attention to the topic at hand *Interpretation, in which the nurse offers an observation as to why the client is changing the topic *Clarification, in which the nurse tries to clarify why the client is asking personal questions *Setting limits, a technique to set the limits regarding what the nurse and client will discuss. Keep in mind that communication should be focused on the client and not on the nurse's personal activities, concerns, or other issues.

This technique is an attempt to understand what the client is saying. The nurse can ask a question such as, "Can you repeat what you just said?" or state, "I don't understand what you mean" to encourage the client to give more information or restate his or her concern. This technique might be needed when caring for clients whose primary language is not English, with teenagers who use slang, or in other situations in which the nurse is unclear of the message being conveyed.

Paraphrasing is used as a reflective technique to better understand what the client is saying. Statements that facilitate this technique include "in other words" or "so you are saying." Paraphrasing offers the client the opportunity to clarify the message and correct any misinterpretations.

Checking perceptions gives the client the opportunity to correct misperceptions that the nurse may have about the communicated message. This can be done by the nurse saying "so this is how you see it" or "I get the feeling that you don't like." Checking perceptions conveys to the client that the nurse wants to understand the client's message.

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this involves directly asking the client specific information. This approach should not be used if the intention is to have a meaningful conversation with a client because direct questions can limit the amount of information the client shares. The two types of questions that the nurse can use with this technique are open-ended and closed questions. Open-ended questions provide the client with an opportunity to elaborate. Examples include questions such as "What do you think about these plans?" and "Tell me what hurts." Closed questions are those that result in a "yes" or "no" response, such as "Are you having pain?" Note that questions that begin with the word "why" may place the client on the defensive and do not usually generate responses that support an ongoing flow of ideas with the client.

: This is a technique nurses can use to create order or help a client establish priorities for action. Structuring is helpful when a client has a number of items on which to focus and might need assistance to determine which one to address first. The nurse can also use this technique to establish guidelines around the nurse-client relationship as to the role of the nurse when helping the client solve problems.

: Nurses use ___________ to call attention to a specific action or statement made by a client. It can be used to help determine the differences between what a client says and what the client does. An example of this technique would be the nurse making the statement, "I heard you say that you are happy about moving in with your daughter, but you appear sad and are crying." Pinpointing helps the nurse to identify inconsistencies between verbal and nonverbal communication.

Nurses can also provide ___________, a method of therapeutic communication in which the nurse shares with the clients how the nurse or others react to the client's statements. Effective feedback is immediate, honest, and supportive. An example of a feedback statement is: "When you look away, I think you are not listening. page 2431 for chart on feedback

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this involves deliberately inviting someone to examine an aspect of their behavior. It is used most often when there is an inconsistency between what a client says and what the client does. When using this technique, the nurse needs to pay close attention to verbal and nonverbal behaviors in order to detect the discrepancy between the messages. this can be either informational or interpretive which consists of using a variety of statements: Including using the word "I" Expressing thoughts and feelings Describing visible behaviors Describing personal feelings Attempting to understand Providing feedback.

this is when the nurse highlights the main ideas that the client expressed during an interaction. It conveys the nurse's comprehension and provides both the nurse and client with an opportunity to review the content of the exchange. This technique can also be used to help focus a client's thinking. If ongoing interactions are occurring between the nurse and client, ____________ the content of a previous conversation can help as a starting point for the current communication. Keep in mind that _____________ should be used to focus on the client's immediate concerns and not the nurse's needs.

When ______________, attention is placed on the dynamics of the nurse-client interpersonal relationship, specifically the content, feelings, and behaviors that were expressed. ________________is an advanced skill and is used most often when a specific level of therapeutic intimacy has been achieved

Help clients manage problems more effectively and develop unused or underused opportunities more fully. Help clients become better at helping themselves in their everyday lives.

client's welfare.

*Respects the client as an individual *Maximizes the client's abilities to participate in decision-making and treatment plans *Considers the client's family relationships and values when planning and providing care *Respects the client's confidentiality *Takes the client's ethnic background and cultural practices into consideration.

Mutual trust Acceptance Respect

preinteraction phase, introductory phase, working or maintenance phase, and termination phase.

The preinteraction phase is similar to the planning stage before an interview. At this stage, the nurse may have basic information about the client, such as: Name Address Age Health problem. This phase of the process may cause feelings of anxiety within the nurse; these can be reduced by identifying specific topics to discuss before meeting the client.

Also called the orientation or pretherapeutic phase, the introductory phase sets the tone for the therapeutic relationship. During this phase, the nurse and client closely examine each other to form an opinion or judgment about each other's behavior. The goal of the introductory phase is to develop trust and security within the relationship. At the beginning of this phase, the nurse may introduce a topic of interest, such as the weather or local event, to put the client at ease. Some clients may be resistant at first, due to fear of exposing feelings, difficulty asking for help, or anxiety or discomfort related to their health concerns. Nurses can help clients overcome their anxieties by demonstrating a caring attitude, genuine interest, and competence. By the end of the introductory phase the client should develop trust in the nurse's competence; believe the nurse is concerned about the client's welfare; feel cultural values, beliefs, and confidentiality are being respected; feel comfortable talking about sensitive issues; understand the purpose of the nurse-client relationship; and be an active participant in the plan of care.

This phase has two stages: exploring and understanding, and facilitating and taking action. The purpose of the working phase is to help the client meet identified goals. To do this, the nurse needs the skills of empathetic listening, respect, genuineness, concreteness, reflecting, paraphrasing, clarifying, and confronting. During this phase, the client may express or demonstrate feelings such as anger, shame, or self-consciousness. Nurses help clients work through these feelings by helping the client make decisions; providing support, and offering options and information.

This phase can be difficult and filled with ambivalence. However, if the relationship has evolved through the other phases, the client will have an improved outlook and be prepared to handle challenges related to his or her health alteration. There will be a sense of loss when the relationship terminates, and the nurse and client both have to use an approach that is comfortable when saying good-bye. This process should begin before the termination phase is reached so that the client has time to adjust when the relationship ends. The nurse can offer follow-up phone calls, emails, or other communication approaches to help ease this transition.

*Utilizing active listening, which helps the nurse identify what the client is feeling *Showing empathy by considering what it feels like to be in the client's shoes *Being honest *Being able to say "I don't know, but I will find out for you," if a situation is beyond the nurse's knowledge or capability *Being genuine and credible Using creativity when addressing problems *Being aware of cultural differences that may affect meaning and understanding *Maintaining client confidentiality and limit the sharing of information to a "need to know" basis *Knowing the role and scope of practice of the nurse.

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By conveying acceptance the nurse respects the child's emotions and allows the child to cry when in pain or lets the child know that crying is okay

The nurse involves the child in the discussion and encourages the child to communicate his point of view. It is important to face the child and parents when speaking. This conveys to the family that the nurse is listening and understands what is being said.

This includes using open-ended questions that allow the child to choose the topic for discussion.

Asking the child to clarify or elaborate on what is being expressed communicates understanding by the nurse.

The nurse should suggest collaboration with the child and family and then assist them through the problem-solving process.

This helps the child to organize her thoughts and focus on the current issue. It will also encourage the child to discuss the issue in more detail.

This guides the direction of the conversation. It is useful with small children who may wish to discuss a variety of topics

This identifies observed behaviors and indicates an interest in the child.

This is particularly important with the behavioral aspect of communication. The nurse acknowledges behaviors that indicate the child's thoughts and feelings.

This indicates that the nurse is available and willing to listen to the child.

The goal of this technique is to help the child and the nurse understand the order of events.

This indicates that the nurse is interested in the discussion and also validates the child's concerns.

This acknowledges to the child that the nurse is listening. It also validates appropriate interpretation of what the child is communicating.

This highlights the key facts of the conversation and also provides an opportunity to consider direction for future discussions. It can also provide closure. Summarizing can occur at varying points in the communication process.

This is when the nurse shares conclusions that have been drawn as a result of the discussions with the child. It provides an opportunity for the child to confirm or deny interpretations that the nurse has made throughout the process.

*Assume a position at the child's eye level to demonstrate respect *Show interest in what the child is doing to encourage security *Agree with the child when appropriate Share experiences with the child to offer encouragement *Compliment the child to reduce anxiety *Use a calm tone of voice and language that is appropriate to enhance comprehension *Use a steady pace so the child does not feel rushed *Use terms that the child can understand *Include the child in care discussions if appropriate for the child's developmental level *Listen more than talk and limit distractions to show interest in what the child has to say *Be truthful to foster development of mutual respect.

Help clients manage problems more effectively and develop unused or underused opportunities more fully. Help clients become better at helping themselves in their everyday lives.