Therapeutic Communication in Nursing

Therapeutic Communication is a important thing in delivering a care for patient, as well as part of nursing skills to achieves nursing goal as part of nursing care plan. Communication is defined as a process of generating and transmitting meaning and it includes verbal and non verbal communication. Successful communication includes appropriateness, efficiency, flexibility, and feedback.

Element of Communication:

• Sender: originator of information
• Message: information being transmitted
• Receiver: recipient of information
• Channel: mode of communication
• Feedback: return response
• Context: the setting of communication

There is five steps in therapeutic communication :

1. Assessment, how to gather information
2. Diagnose
3. Planning and setting goals
4. Implementation
5. Evaluation

Before or during intervention, as a nurse should :

• Consider factors which influence effective verbal communication
• Use special communication aids as needed
• Use planned therapeutic communication techniques
• Avoid nontherapeutic techniques

Therapeutic Communication Techniques:

• Encouraging formulation of a plan of action
• Clarifying and validating
• Focusing and refocusing
• Give information and presenting reality
• Listening
• Maintain neutral responses
• Maintain silence
• Provide acknowledgment and feedback
• Provide nonverbal encouragement
• Restating
• Reflecting
• Share perceptions
• Use broad opening and open-ended question
• Summarizing

Nontherapeutic Communication Techniques:

• Be defensive or challenging the client
• Ask the client “why”
• Change the subjects
• Give advice or approval or disapproval
• Make value judgment
• Make stereotypical comments
• Place the client’s feeling on hold
• Provide false reassurance

Nurse - Client Relationship

Nurse – Client relationship is essential in nursing practice. The basic element of the relationship between nurse and client depends on the interaction of thought, feeling, and action of each person. The patient will experience better health when all their needs are fully considered in the relationship (Peplau, Interpersonal Relation 9).

Nurse establishes and maintains this relationship by nursing knowledge and skills, as well as applying caring attitudes and behaviors. This nurse – client relationship is based on trust, respect, empathy and professional intimacy.

There are principles in establishing nurse – client relationship :

• Care for the client in holistic manner
• Maintain genuineness, respect, empathy and concreteness
• Assess religious and spiritual practice of patient
• Assess cultural beliefs and values
• Honest and open communication
• Encourage expression of the client’s feeling
• Established in appropriate limits
• Help the client to develop resources

PHASE OF THERAPEUTIC NURSE-CLIENT RELATIONSHIP


Preinteraction phase. It begins before the nurse’s first contact with client, self exploration about his or her values and feeling for caring for the client

Orientation Phase. In this phase, the nurse establish boundaries, acceptance, ant trust with client, identify the expectation and assess the anxiety in the client. Goals are defined with the client in this phase, as well as preparing the client for termination or separation of relationship.
Working Phase. Nurse promotes an attitude of acceptance and assist the client to express feelings by using the constructive coping mechanisms, and increase the client’s independence.

Termination or Separation Phase. This is the end of all phase in which the nurse prepares the client for termination and separation on initial contact and evaluate progress and achievement of goals. Nurse encourage the client to discuss the feeling about termination and never promise the client that the relationship will be continued. This is times to refer and transfer the client to other available support systems.